Published by the Rangpur Medical College, Rangpur. Full-text articles available. Articles in the Journal of Rangpur Medical College are Open Access articles published under the Creative Commons CC BY-NC-ND License Attribution-NonCommercial-NoDerivatives 4.0 International License
Prognostic Value of Cardiac Troponin I for In-hospital Recovery in Patients with ST-Elevation Myocardial Infarction
Introduction: ST-elevation myocardial infarction (STEMI) remains a common cause of cardiovascular mortality, with accurate risk stratification for the appropriate management of the patient. Cardiac troponin I (cTnI) has been identified as a potential prognostic biomarker, as well as in its diagnostic role. Objective: This study aimed to evaluate the prognostic significance of cardiac troponin I level for in-hospital recovery and complications in patients with STEMI. Methods: A cross-sectional study was conducted on 100 STEMI patients aged 30-70 years. The patients were categorized into three groups based on serum troponin I concentration: <0.034 ng/mL (low risk), 0.034-0.12 ng/mL (intermediate risk), and _0.12 ng/mL (high risk). In-hospital mortality, complications (arrhythmia, heart failure, cardiogenic shock), and length of stay in the hospital were the primary outcomes of interest. Statistical analysis was performed on SPSS version 26 using chi-square tests and binary logistic regression. Results: The study population had a mean age of 52.5±13.1 years with 59% male preponderance. There was a clear-cut dose-response relation observed between troponin levels and adverse outcomes. In-hospital mortality increased step-wise in low, intermediate, and high-risk troponin groups (0%, 3.4%, 38.5% respectively; p<0.001). Cumulative complication rates also followed a similar pattern (3.7%, 68.4%, 100% respectively; p<0.001), with specific complications like arrhythmias (0%, 33.3%, 46.1%), heart failure (0%, 23.3%, 30.7%), and cardiogenic shock (1.3%, 11.6%, 23.0%). Hospital stay was also significantly related to the troponin levels, with prolonged hospitalization (>7 days) in 0%, 6.7%, and 76.9% in respective groups (p<0.001). Multivariate analysis also endorsed troponin _0.12 ng/mL as an independent predictor of mortality with a 49-fold increased risk (OR=49.8, 95% CI: 5.3-463.2, p<0.001). Conclusion: The study highlights the optimal prognostic value of cardiac troponin I levels in the prediction of in-hospital outcomes among STEMI patients. The proposed risk stratification system can be applied to inform decisions for clinical management, deployment of resources, and patient care approach in acute cardiac care units. J Rang Med Col. September 2025; Vol.10, No.2:3-7
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Bone Mineral Density Evaluation of Postmenopausal Women with Type 2 Diabetes Mellitus
Introduction: Osteoporosis, marked by reduced bone mass and increased fracture risk, is common in postmenopausal women due to estrogen deficiency. Type 2 diabetes mellitus may further compromise bone health. Objective: This study aimed to evaluate bone mineral density in postmenopausal women with T2DM to assess their risk of osteoporosis. Methods: This cross-sectional analytical study was conducted in the Medicine Department of Sir Salimullah Medical College and Mitford Hospital during the study period. A total of 120 cases were included in this study according to the selection criteria. Data were processed and analyzed by SPSS 22.0. A p-value of <0.05 was considered statistically significant. Results: Mean age of the patients was 65.83±8.75 years and 62.17±7.67 years in diabetic and non-diabetic post-menopausal patients. Mean duration of DM was 10.53±5.09 years, and mean duration since menopause was 19.70±7.82 years. Osteoporosis was 38(63.3%) and osteopenia was 20(33.3%) in the diabetic group, and osteoporosis was 24(40.0%) and osteopenia was 31(51.7%) in the non-diabetic group. Conclusion: Postmenopausal women with type 2 diabetes mellitus exhibited significantly reduced bone mineral density and a higher prevalence of osteoporosis compared to their healthy counterparts, highlighting the need for early screening and proactive management to mitigate fracture risk. J Rang Med Col. 2025 Sep;10(2): 8-12
Clinico-sonographic Correlation and Predictors of Polycystic Ovarian Syndrome
Background: The clinico-sonographic correlation of PCOS involves linking a patient's clinical symptoms with ultrasound findings of polycystic ovarian morphology (PCOM). Objective: This study aimed to assess the relationship between clinical features with ultrasound findings to identify predictors of PCOS severity. Methods: The cross-sectional study was conducted in Outpatient Department (OPD) of Obstetrics & Gynecology, Bangladesh Medical University, Dhaka, Bangladesh from July 2024 to June 2025on PCOS women aged 18-40 years as diagnosed by the Rotterdam criteria. All the subjects were put through extensive clinical examination, including menstrual history, anthropometric measurements, and inquiry regarding hyperandrogenic signs. Pelvic ultrasonography was performed to assess ovarian volume, stromal echogenicity, and follicular morphology. The associations between clinical presentation and ultrasonographic features were performed on SPSS version 26, including chi-square tests, Pearson correlation, and multivariable logistic regression. Results: Bilateral polycystic ovarian morphology was observed in 70% of the subjects. Strong positive correlations were observed between oligomenorrhea (77%; p=0.014), amenorrhea (72%; p=0.018), and infertility (85.7%, p=0.013) with bilateral PCO. Similarly, acne (82.8%, p=0.009), hirsutism (80%, p=0.04) and BMI ≥30 (82.4%; p=0.021) showed moderate correlations with bilateral PCO. Oligomenorrhea was the strongest predictor (aOR=3.8, 95% CI: 1.6-9.0, p=0.002), followed by infertility (aOR=3.2, p=0.004), amenorrhea (aOR=2.9, p=0.015), acne (aOR=2.4, p=0.028), and obesity (aOR=2.1, p=0.047). Hirsutism was of borderline significance (aOR=1.9, p=0.073). Conclusion: Clinical symptoms are strongly correlated with ultrasonographic presentation in PCOS. Menstrual irregularities, especially oligomenorrhea and amenorrhea, and infertility strongly predict bilateral polycystic ovarian morphology, exemplifying the combined hormonal-morphological pathogenesis of PCOS. J Rang Med Col. 2025 Sep;10(2): 13-19
Temporal Bone Squamous Cell Carcinoma: Diagnostic Delays and Impact on Survival
Introduction: Temporal bone squamous cell carcinoma (TBSCC) is a rare, aggressive malignancy frequently associated with poor prognosis due to its typically late diagnosis. Objective: This study aimed to analyze diagnostic delays in TBSCC patients, assessing their impact on tumor staging and survival to improve clinical management and healthcare systems. Methods: This retrospective study was conducted at Rajshahi Medical College, Rajshahi, Bangladesh, from June 2020 to July 2021on 150 patients diagnosed with TBSCC. Patients' records were reviewed for demographic information, clinical history, diagnostic timelines, tumor staging, treatment methods, and survival outcomes. They measured diagnostic delays in three intervals: from symptom onset to the first medical visit, from the first visit to the histological diagnosis, and the overall delay. Survival data were gathered over a 3-year follow-up period. The statistical analysis was conducted on SPSS v26.0, including descriptive statistics, chi-square tests, and Kaplan-Meier survival analysis. Results: Most of the study participants were male (64%) with an average age of 58.3 years. Patients mostly lived in rural areas (61.3%) and had significant smoking histories (54.7%). There were notable diagnostic delays, with 30.7% of patients experiencing total delays of more than six months. Advanced-stage disease (Stage III-IV) was found in 66.7% of the patients. The three-year survival rate was 56.0%. Survival was strongly linked to tumor stage (Stage I: 88.9% vs Stage IV: 25.0%, p=0.007) and diagnostic delay (_3 months: 77.5% vs >6 months: 32.6%, p=0.004). Conclusion: Delays in diagnosis significantly affect survival in TBSCC. Late diagnosis often results in advanced-stage cancer and lower survival rates. Early detection strategies and better access to healthcare are essential for improving outcomes in this aggressive disease. J Rang Med Col. 2025 Sep;10(2): 20-25
Enterocutaneous Fistula Following Surgical Treatment of Traumatic Gut Injury: A Single-Center Hospital-Based Study
Background: Enterocutaneous fistula (ECF) is a serious complication that can occur after surgery for traumatic gut injuries. It leads to significant health problems, increased death rates, and high healthcare costs. Objective: This study scrutinized the incidence, presentation, and factors influencing enterocutaneous fistula formation after surgical treatment of traumatic gut injuries at a tertiary care center. Methods: This retrospective observational study looked back at cases from the Casualty Surgical Department, Dhaka Medical College Hospital (DMCH), between July 2006 to June 2007, including patients with traumatic gut injuries, whether blunt or penetrating, who had undergone laparotomy using pre-designed case record forms. Statistical analysis was performed using SPSS version 26. Results: Among the 139 patients, 132(95%) were male, with an average age of 31 to 40 years. The most frequent cause of injury was road traffic accidents (32.3%), followed by stab wounds (30.2%) and gunshot injuries (24.4%). Twelve patients (8.63%) developed enterocutaneous fistula. The highest incidence of fistulas occurred in patients aged 31 to 40 years (41.6%). Conclusion: Timely recognition of injuries and appropriate surgical treatment may help lower the rate of this complication. J Rang Med Col. 2025 Sep;10(2): 26-32
Cardiovascular Sympathetic Function Status by Cold Pressor Test in Lactating Mothers
Background: Lactation has a significant impact on women cardiac autonomic control and various cardiometabolic changes which occurs during lactation that influence women health. Objective: The study was aimed to assess the cardiovascular sympathetic functions status by the cold pressor test in lactating mothers. Methods: This cross-sectional analytical study was conducted in the Department of Physiology, Rangpur Medical College, Rangpur from July 2022 to June 2023. After obtaining permission, a total 100 subjects who were met the inclusion criteria and enrolled in the study after briefing them objectives of the study. Among them 50 apparently healthy lactating mothers (Group A) and 50 apparently healthy non-lactating mothers (Group B) were selected through purposive sampling. The evaluation of sympathetic functions in selected individuals was done by cold pressor test. The individuals were selected from Breast Feeding or Lactating Corner, Out Patient Department of Paediatrics. For statistical analysis, unpaired ‘t’ test was performed by computer-based software SPSS-25 version for windows. Results: Resting systolic and diastolic blood pressure was significantly higher (P<0.001) in lactating mothers. After cold pressor test the mean change of both systolic and diastolic blood pressure response by cold pressor test was significantly higher (p<0.01) in lactating mothers group compared to control group. Conclusion: Increased resting systolic and diastolic blood pressure in lactating mothers and increased diastolic blood pressure response by cold pressor test in lactating mothers indicate increased sympathetic functions. J Rang Med Col. 2025 Sep;10(2): 33-37
Incidence of Early Postoperative Complications Following PLIF with Cage and Decompression in the Management of Lumbar Spinal Canal Stenosis
Introduction: Lumbar spinal canal stenosis (LSCS) is a common degenerative condition that leads to compression of neural elements, causing back pain, neurogenic claudication, and functional disability. When conservative treatments fail, surgical intervention becomes necessary. Objective: This study aimed to evaluate types of early postoperative complications observed in patients undergoing posterior lumbar interbody fusion (PLIF) with cage and decompression for lumbar spinal canal stenosis. Methods: This prospective study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to August 2022, involving 15 patients diagnosed with lumbar spinal stenosis.The collected data were compiled and analyzed using SPSS version 25.0. Results: Among the 15 patients who underwent PLIF with cage and decompression for lumbar spinal canal stenosis, the majority were aged 31-45 years (53.33%), and slightly more were male (53.33%). Most had stenosis at the L4/L5 level (53.33%), and housewives formed the largest occupational group (46.67%). Postoperatively, only 4 patients (26.66%) experienced early complications-2 developed urinary tract infections and 2 had superficial wound infections. Conclusion: PLIF with cage and decompression appeared to be a safe and effective surgical option for lumbar spinal canal stenosis, with a low incidence of early complications. In this study, only minor issues like urinary tract infections and superficial wound infectionswere observed in a small number of patients, underscoring the procedure's overall safety in a controlled clinical setting. J Rang Med Col. 2025 Sep;10(2): 38-42
Efficacy of Vacuum-Assisted Closure (VAC) Therapy in the Treatment of Diabetic Foot Ulcer
Introduction: Diabetic foot ulcers (DFUs) are among the most serious and challenging complications of diabetes mellitus, frequently leading to infection, prolonged hospitalization, and lower-limb amputation. Objective: This study aimed to evaluate the rate of complete wound closure and complications of VAC therapy in treating diabetic foot ulcers. Methods: This prospective observational study was conducted at a specialized diabetic foot care centre in Dhaka over 18 months (April 2020 to October 2021) and included 90 patients with Wagner’s grade 2 to grade 4 diabetic foot ulcers (DFUs).Vacuum-assisted closure (VAC) therapy was administered. Dressings were changed every 6–7 days, and each patient underwent 2–5 treatment cycles according to ulcer severity Data analysis was done by SPSS version 25.0. Results: Among 90 diabetic foot ulcer patients, male (80%) was predominant, with a mean age of 54.35 years. Most ulcers were Wagner grade 3(40%). Treatment outcomes showed that 21.6% achieved complete ulcer closure, while secondary closure and skin grafting accounted for 31.4% and 23.3%, respectively. Hospital stays ranged from 4 to 10 days, and healing time to granulation varied between 18 and 40 days. Complications were rare, affecting only 5.5% of patients, primarily due to minor bleeding or wound deterioration. Conclusion: VAC therapy is an effective and safe treatment for diabetic foot ulcers, significantly enhancing wound healing and reducing hospital stay. Its low complication rate and positive clinical outcomes support its use as a valuable modality in managing DFUs. J Rang Med Col. 2025 Sep;10(2): 43-48
Association of Amniotic Fluid Index (AFI) with Maternal and Perinatal Complications in Premature Rupture of Membranes
Background: Premature rupture of membranes (PROM) at term complicates 8–10% of pregnancies and increases the risk of maternal and perinatal complications. Amniotic fluid index (AFI), a key indicator of fetal well-being, may influence delivery outcomes in PROM cases. Objective: The study evaluated the association between AFI levels and maternal-neonatal complications in term PROM patients. Methods: The prospective observational study included 126 pregnant women with the term PROM, grouped into two categories based on AFI values: Group A (AFI >5cm, n=76) and Group B (AFI <5cm, n=50). Latency period, mode of onset of labour, type of delivery, and maternal and neonatal complications were followed up in the participants. Results: Both groups had comparable demographic characteristics and latency duration. Group B (AFI <5cm) exhibited a significantly greater rate of labour induction (80% vs 52.6%, p=0.001) and caesarian section (86% vs 50%, p=0.002). Maternal and neonatal complications occurred significantly more often in Group B (62% vs 7.9%, p<0.001) and (62% vs 0.03%, p<0.001) respectively. Conclusion: In PROM patients, oligohydramnios (AFI <5cm) is significantly associated with augmented labour induction, caesarian delivery, and maternal and neonatal complications. J Rang Med Col. 2025 Sep;10(2): 49-54
Assessment of Foot Length for Estimation of Small for Gestational Age in Rural Area
Background: Neonatal period is the most vulnerable for Small for Gestational Age (SGA) new-borns for survival.About 60% of the new-borns who born term but have low birth weight due to fetal growth restriction termed as Small for Gestational Age (SGA). The burden of SGA newborn is very high in countries of low and middle income and is concentrated high in South Asia. Identifying these low-birth-weight SGA newborns and referring them to higher centers for effective interventions would help in decreasing neonatal mortality and morbidity. Among the anthropometric measurements, birth weight is the single gold standard for identification SGA but assessment of accurate BW in rural areas where weight machine and trained personnel are not available specially in home deliveries, other simple and easier anthropometric measurement of the newborn may be as important. Foot length is a screening tool that may be simple but accurate to identify small new-born in need of extra care in rural settings of developing country like Bangladesh. Neonatal foot length (FL) has been proposed as a stable and reliable alternative, as it is less affected by intrauterine growth restriction (IUGR). Objective: To compare mean foot length in term Appropriate for Gestational Age (AGA) and SGA newborns, to assess the correlation between foot length and gestational age in both groups and to determine if foot length can help to differentiate between AGA and SGA infants when GA is uncertain. Methods: This cross-sectional, analytical study was conducted in the Department of Anatomy, Rangpur Medical College, Rangpur from July 2020 to June 2021 on 200 newborns of both sexes with gestational age between 37 and 42 weeks. The newborn was selected and measured within 24 hours of birth. 100 term newborns weighted<2.5 kg regarAded as SGA were the case and another 100-term newborns weighted>2.5 kg regarded as AGA served as control. The birth weight, foot length were measured and a comparison was done between AGA and SGA newborns. Data was analyzed by using a statistical package for social sciences (SPSS version 26). Result: The mean± SD of birth weight in AGA and SGA groups was 2.99±0.31kg and 2.10±0.24kg respectively, it was observed that the mean±SD of foot length in AGA group was 8.41±0.74cm and was 7.17±0.81cm in SGA group. Both BW and foot length was significantly higher in AGA group than SGA group. Again, foot length was significantly correlated with birth weight in both AGA and SGA groups. Conclusion: Foot length of SGA newborns are as effective as birth weight measurement to predict birth weight in SGA newborns Keywords: Appropriate for gestational age (AGA), Small for gestational age (SGA), Birth weight (BW), Foot length (FL). J Rang Med Col. 2025 Sep;10(2): 55-59
Surgical Complexity and Intraoperative Obstacles in Mastoidectomy: A Retrospective Study at JRRMCH, Sylhet
Background: Mastoidectomy is a complex otologic procedure with difficult anatomical navigation through the temporal bone. Despite technological advancements, intraoperative difficulties are frequent and may significantly affect surgical outcomes. It is important to understand the predictors and types of intraoperative problems for surgical planning and optimization of patient safety, particularly in low-resource settings. Objective: This study aimed to examine the relationship between surgical complexity, intraoperative complications, and patient or procedural variables in mastoidectomy, providing evidence for surgical planning and risk stratification. Methods: This is a retrospective observational study conducted in Jalalabad Ragib-Rabeya Medical College Hospital (JRRMCH), Sylhet, on 100 mastoidectomy cases operated upon from January 2022 to December 2024. Patient demographics, surgical indications, comorbidity, mastoidectomy type, intraoperative complications, and postoperative outcomes were analyzed. Surgical complexity was graded based on intraoperative findings. Data analysis was performed using SPSS version 27, and significance was considered at p<0.05. Results: Intraoperative challenges were faced by 40% of patients. While age, sex, and comorbidities were not significantly related to the occurrence of challenges (p>0.05), surgical technique was. CWD procedures were more strongly linked to challenges (50%) compared to cortical mastoidectomy (30%) (p=0.002). Bleeding (50%), poor anatomical visualization (62.5%), facial nerve dehiscence (25%), and dura exposure (20%) were the intraoperative challenges, all of which were statistically significant (p<0.001). Cortical mastoidectomy, however, was more frequently associated with uncomplicated procedures. Conclusion: Mastoidectomy type significantly affected intraoperative complexity, with CWD procedures posing more risk for complications. Preoperative identification of high-risk cases and tailored surgical planning are required to minimize intraoperative challenges and optimize outcomes. These findings underscore the need for improved risk stratification and operative preparedness, especially in settings with limited surgical resources. J Rang Med Col. 2025 Sep;10(2): 60-65
Polytrauma in Emergency Settings: A Multidisciplinary Approach to Skeletal and Neurological Stabilization
Introduction: Polytrauma is a leading contributor to morbidity and mortality globally, particularly in low- and middle-income countries. Objective: This study evaluated the epidemiological trends, injury profiles, and outcomes of polytrauma patients in an emergency setting in Bangladesh, with a focus on skeletal and neurological stabilization and the role of multidisciplinary care. Methods: A 12-month prospective observational study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka, on 120 adult polytrauma patients (_18 years) presenting within 6 hours of injury. Data collected included demographics, injury types, Glasgow Coma Scale (GCS), interventions, ICU admissions, and functional outcomes via Glasgow Outcome Scale (GOS). Cox proportional hazards modeling was applied to identify predictors of recovery. Results: The mean age was 38.2±14.6 years; 65% were male. Road traffic accidents accounted for 60% of injuries. Long bone fractures (51.7%) and TBIs (46.7%) were most frequent. External fixation was the most common intervention (35%). Multidisciplinary management was provided in 63.3% of cases and significantly improved outcomes (p<0.001). Mortality was 11.7%; 48.3% achieved good recovery (GOS 5). Cox analysis showed better outcomes with multidisciplinary care (HR=1.68, p=0.009), higher GCS, and younger age. Conclusion: Multidisciplinary trauma care is vital for improving functional outcomes in polytrauma. Early stabilization and collaborative interventions should be prioritized in resource-limited emergency settings. J Rang Med Col. 2025 Sep;10(2): 66-71
Evaluation of Risk Factors Associated with First Febrile Seizure: A Hospital Based Case-Control Study
Introduction: Febrile seizures (FS) are the most prevalent type of seizures seen in paediatric practice, yet the underlying causes remain poorly understood. Objective: This study aimed to identify risk factors associated with the first febrile seizure in children aged 6 months to 5 years. Methods: This hospital-based case-control study was conducted from January to December 2024 at the Paediatrics Department of Jalalabad Ragib-Rabeya Medical College Hospital in Sylhet including 200 children aged 6 months to 5 years, with 100 cases admitted for their first febrile seizure and 100 controls admitted for fever without a history of seizures. Data were collected using a pre-designed semi-structured questionnaire and statistical analyses, including the Chi-square test, Student’s t-test and odds ratio calculations were performed to compare risk factors between the two groups. Results: The mean age of children in the case vs control group was insignificant (17.17±8.22 vs 18.89±14.83 months; p=0.3116). However, boys exhibited a significantly higher risk of developing FS, with the odds of boys experiencing FS being twice that of girls (95% CI=1.1578 to 3.6980, p=0.0141). A family history of febrile seizures was notably linked to the occurrence of first febrile seizure, with eight times greater odds for affected children (95% CI=3.355 to 21.209, p<0.0001). There was no significant correlation identified between a family history of epilepsy and the first febrile seizure. Children who were exclusively breastfed had a lower susceptibility to febrile seizures (OR=0.409, 95% CI=0.1924 to 0.8090, p=0.0202). Antenatal and perinatal complications were significantly higher in the case group than the control group (p<0.05). The mean admission temperature for cases was significantly higher at 100.92±1.540F compared to 100.28±1.460F in controls (p=0.0029). Upper respiratory tract infections (URTI) emerged as the most common trigger for febrile seizures (p< 0.001) and serum sodium levels were significantly lower while serum calcium and random blood sugar levels were significantly higher in the case group (p<0.05). Conclusion: Male gender, positive family history of febrile seizures, inadequate exclusive breastfeeding, elevated body temperature, antenatal and perinatal complications, upper respiratory tract infections as well as abnormal serum sodium, calcium, and blood sugar levels were significant risk factors for the first episode of febrile seizure. Addressing and mitigating these risk factors could significantly reduce the incidence of febrile seizures in children. J Rang Med Col. 2025 Sep;10(2): 72-78
Performance of Radiological Diagnosis of Malignant Lesions of Lung
Background: Lung cancer is the leading cause of death in Bangladesh especially in the northern zone. CT guided core biopsy of lung helps in confirming histopathological diagnosis of lung tumor. Radiological performance for diagnosing lung malignancies relies on methods like CT, though sensitivity, specificity, and accuracy can vary based on lesion size and radiologist experience. Methods: This cross-sectional study was conducted at Department of Respiratory Medicine, Rangpur Medical College, Rangpur, Bangladesh from January 2023 to December 2023 on 102 patients with suspected bronchial carcinoma. CT scan of chest was performed for all the patients followed by CT guided core biopsy of lung for histopathology. Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), and accuracy of radiological diagnosis were calculated. Results: Most patients (63%) were aged 51-70, with a male-to-female ratio of 2.6:1. CT scans showed 79% with bronchial neoplasm and 21% with inflammation. Histopathology revealed 77% had bronchial carcinoma, with various types identified, Adenocarcinoma (29%), Squamous cell carcinoma (43%), Small cell carcinoma (16%), neuroendocrine carcinoma (6%), metastatic leiomyosarcoma (1.2%), metastatic GIST (1.2%) and undifferentiated carcinoma (1.2%). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), and accuracy of radiological diagnosis of bronchial carcinoma were respectively 100%, 91.3%, 97.5%, 100% and 98.0%. Conclusion: CT scan can differentiate malignant lesions from inflammatory lung lesions with high performance, though histological confirmation of malignant lesions are mandatory. J Rang Med Col. 2025 Sep;10(2): 79-83
Incidence, Risk Factors and Post-Operative Outcome of Cesarean Hysterectomy Among Placenta Previa Patients at a Tertiary Hospital
Introduction: Placenta previa remains a significant obstetric complication associated with maternal morbidity, particularly when coupled with abnormal placentation and previous cesarean deliveries. Objective: This study aimed to assess the incidence, risk factors, and postoperative outcomes of cesarean hysterectomy among placenta previa patients at a tertiary hospital in Bangladesh. Methods: The cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College and Hospital, over a period of six months, from July 2017 to December 2017, including 50 pregnant women with confirmed placenta previa. Results: Cesarean hysterectomy was required in 20% of placenta previa cases, predominantly among patients with central placenta previa and prior cesarean deliveries. Multiparity, irregular or absent antenatal care, and a history of uterine curettage were prominent risk factors. Postoperative complications occurred in 50% of hysterectomy cases. Despite a high live birth rate (90%), 30% of newborns had low birth weight, and 24% required NICU admission. Conclusion: Cesarean hysterectomy remains a vital but high-risk intervention in managing complicated placenta previa. Early identification of high-risk patients, rational use of cesarean sections, and coordinated multidisciplinary care are essential to reduce maternal and perinatal complications. J Rang Med Col. 2025 Sep;10(2): 84-89
Radiologic-Pathologic Correlation in Middle Ear Malignancies: Insights for Early Detection and Surgical Planning
Introduction: Middle ear cancers are rare but aggressive tumors with a poor outlook due to late diagnosis and complicated anatomy. It is essential to correlate radiologic findings with pathologic details for accurate staging, effective surgical planning, and optimal outcomes. Objective: This study aimed to examine the link between radiologic and pathologic data in middle ear cancers and their effect on early detection and surgical choices. Methods: We conducted a prospective study involving 100 patients with confirmed middle ear cancers, conducted at Rajshahi Medical College, Rajshahi, Bangladesh, from January 2024 to December 2024. We performed high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone, focusing on bone erosion, mastoid involvement, petrous apex involvement, and intracranial spread. The pathologic evaluation included histologic type, perineural invasion, lymph vascular invasion, and margin status. Data were analyzed using SPSS v26.0 to calculate Pearson correlation coefficients to measure the agreement between radiologic and pathologic findings. Results: The study included 56% males with an average age of 51.2 years. Squamous cell carcinoma was the most common histologic type (62%). We found strong correlations between intracranial extension and dural/brain invasion (r=0.88), bone erosion and histologic bone invasion (r=0.82), and mastoid involvement with pathologic mastoid invasion (r=0.79). Radiologic findings changed the surgical plan in 34% of cases, with 78% achieving local control and 81% surviving for one year. Conclusion: The strong links between radiologic and pathologic findings in middle ear cancers ensure accurate preoperative staging and surgical planning, leading to better local control and survival outcomes. High-resolution imaging is crucial for effective management strategies. J Rang Med Col. 2025 Sep;10(2): 90-96
Sympathetic Cardiovascular Nerve Function Status in Overweight Individuals
Background: Overweight can lead to adverse health outcomes such as increased cardiovascular disease risk and chronic conditions that decrease overall quality of life. Reduced sympathetic activity represents a preclinical marker in the pathogenesis of cardiovascular disease in overweight individuals. Objective: The study aimed to assess the cardiovascular sympathetic nerve function status in normal weight and overweight individuals. Methods: This cross-sectional analytical study was conducted from July 2017 to June 2018 in the Department of Physiology, Rangpur Medical College, Rangpur, Bangladesh. After obtaining permission the participants who would meet the inclusions and exclusions criteria were enrolled in the study after briefing them about objectives. A total number of 80 age, sex matched individuals were selected, among them 40 were apparently healthy normal weight individuals (group-A) and 40 were apparently healthy overweight individuals (group-B). Two simple noninvasive cardiovascular reflex tests like blood pressure response to sustained handgrip and standing were done to assess cardiovascular sympathetic nerve functions status. Baseline systolic and diastolic blood pressure recording was done during resting condition. The participants were selected by purposive sampling method from different areas of Rangpur division, Bangladesh. For statistical analysis, unpaired ̒t̕ test was performed by computer-based software SPSS 23.0 version for windows. Results: Overweight individuals had both higher mean systolic blood pressure (p<0.05) and mean diastolic blood pressure than normal weight individuals in resting condition. And overweight individuals had lower blood pressure response to sustained handgrip (p<0.05) and standing (p>0.05) than normal weight individuals. Rise of mean diastolic blood pressure in response to sustained handgrip in overweight was significant (18.2±2.86 vs 15.68±5.17; p=0.24) but fall of mean systolic blood pressure in response to standing in overweight was not significant (8±2.95 vs 6.68±2.8; p=0.105). Conclusion: Reduced sympathetic activity in overweight individuals indicate modifications in cardiovascular autonomic nerve functions and this could make them prone to future development of various cardiovascular complications. J Rang Med Col. 2025 Sep;10(2): 97-102
Relationship Between Headache and Lifestyle Among Children and Adolescents
Background: Headaches are a common issue among children, affecting their daily functioning and quality of life. Objective: This study aimed to explore the distribution of headaches in children, examining factors such as age, sex, BMI, dietary habits, sleep patterns, and potential triggers. Methods: A cross-sectional study was conducted on 245 children aged 7 to <18 years, including 120 diagnosed with Migraine or Tension-Type Headache (TTH) at pediatric OPD of National Institute of Neurosciences and Hospital, Dhaka, and 125 age-matched healthy siblings. Headache diagnoses followed ICHD-3 criteria. A structured questionnaire was administered to gather data on lifestyle factors such as sleep patterns, dietary habits, leisure activities, BMI, environmental triggers, academic stress, and family dynamics. Data collection was carried out through face-to-face interviews with parents and children, after obtaining informed consent. SPSS software was used for data analysis. Results: Among the headache group, 45% of children with Migraine and 66.7% of those with TTH were in the 10-12 years age group. The study revealed a significant relationship between abnormal sleep patterns (sleep latency >30 minutes, <8 hours sleep duration, TV/mobile usage before sleep, and daytime naps) and the occurrence of headaches (p<0.05). However, no significant associations were found with other lifestyle factors like diet, physical activity, or obesity. Conclusion: The findings suggest a significant relationship between sleep disturbances and headaches in children. Given the impact on quality of life, further research is needed to explore the broader lifestyle influences on headache prevalence among children and adolescents. J Rang Med Col. 2025 Sep;10(2): 103-108
Postoperative Relief and Complications in Eagle’s Syndrome: A Retrospective Analysis
Introduction: Eagle’s Syndrome (ES) is a rare clinical condition characterized by symptomatic elongation of the styloid process or calcification of the stylohyoid ligament. Objective: The objective of the study was to evaluate postoperative symptom relief and complication rates following styloidectomy in patients with radiologically confirmed Eagle’s Syndrome. Methods: A retrospective review was conducted on 90 patients diagnosed with ES and treated surgically at a tertiary center in Bangladesh. Demographic data, symptom profiles, surgical approaches, and postoperative outcomes were analyzed. Symptom relief was assessed using the visual analog scale (VAS), and complications were recorded. Correlation between symptom duration and postoperative improvement was calculated. Results: Most patients were female (60%) and aged 46–60 years (40%). Throat pain (80%) and dysphagia (53.3%) were the predominant presenting symptoms. Intraoral styloidectomy was performed in 66.7% of cases. Complete relief was observed in 83.3% for throat pain, 80% for otalgia, and 72.9% for dysphagia. Complications were low (18.9%), with transient dysphagia (6.7%) and wound infection (5.6%) being most common. A significant correlation was found between shorter symptom duration and greater relief (r=0.9999, p=0.0107). Conclusion: Surgical management of Eagle’s Syndrome yielded high symptom resolution and minimal complications, particularly when intervention was timely. Early diagnosis was crucial for optimal outcomes. J Rang Med Col. 2025 Sep;10(2): 109-114
Efficacy of a Single 5,000 IU Dose of HCG in Enhancing Pregnancy Outcomes During Early Gestational Period
Background: Human chorionic gonadotropin (HCG) has an important role in maintaining early pregnancy and has been studied to improve pregnancy outcomes. Objective: This study aimed to assess the effectiveness of a single 5,000 IU dose of HCG in improving early pregnancy outcomes for women at risk of complications. Methods: This prospective study was conducted at the Salauddin Specialized Hospital, Dhaka, Bangladesh, from January 2023 to January 2024 on 120 pregnant women in the early stages of pregnancy at 6 weeks without cardiac pulsation and positive β-hCG levels. They were randomly divided into two groups: the HCG group (n=60), which received 5,000 IU of intramuscular HCG, and the control group (n=60), who received standard care. The main outcomes included ongoing pregnancy rates, miscarriage rates, positive HCG levels, fetal heartbeat detection at 8 weeks, and hormone levels measured on day 5 after the injection. Results: The ongoing pregnancy rates were higher in the HCG group compared to the control group (86.7% vs. 70.0%, p=0.03). The miscarriage rate was lower in the HCG group (13.3% vs. 30.0%, p=0.03). Those who received HCG also had a higher chance of fetal cardiac pulsation positivity (83.3% vs. 66.7%, p=0.04) and a lower incidence of threatened abortion (10.0% vs. 23.3%, p=0.05). Biochemical analysis revealed higher levels of β-hCG (>1,500 IU/L; 91.7% vs. 71.7%, p=0.01) and progesterone (>10 ng/mL; 83.3% vs. 65.0%, p=0.02). We found weak-to-moderate correlations (r=0.25–0.34, p<0.05) linking HCG to positive outcomes, indicating its role in maintaining pregnancy. Conclusion: Administering a single dose of HCG significantly improved early pregnancy (at 6 weeks without cardiac pulsation and positive β-hCG levels) outcomes by providing better hormonal support and reducing complications. These results suggest that HCG supplementation may be helpful for women at risk of early pregnancy loss, though further large-scale studies are necessary. J Rang Med Col. 2025 Sep;10(2): 115-120
Predicting Dengue Patterns: A Community-Based Prospective Study in Bangladesh
Background: Dengue continues to pose a major public health threat in Bangladesh, particularly during seasonal outbreaks exacerbated by climatic and environmental conditions. Objective: This study aimed to predict dengue transmission patterns using a community-based prospective design that integrates demographic, environmental, entomological, and laboratory variables. Methods: A total of 300 participants were enrolled for this study which was conducted in President Abdul Hamid Medical College, Kishoregonj, Bangladesh, from March 2023 to October 2023. Data were collected on sociodemographics, vector breeding sites, preventive practices, climate parameters, and laboratory confirmation of dengue cases. Multiple linear regressions were used to identify significant predictors of dengue incidence. Results: Among confirmed cases, 70% were mild, 25% hospitalized, and 5% resulted in death. Most cases (60%) occurred during the monsoon season. Larvae were identified in 70% of breeding sites, with abandoned tires and water tanks as major sources. While 40% of households showed high awareness, preventive practices were inconsistently followed. NS1 and IgM positivity were recorded in 65% and 70% of cases, respectively. Rainfall (p=0.001) and breeding sites (p=0.028) were statistically significant predictors in the regression model, which achieved 75% prediction accuracy. Conclusion: Rainfall and breeding site density are key predictors of dengue outbreaks. Community-based models integrating environmental, behavioral, and diagnostic data are crucial for effective dengue forecasting and control in Bangladesh. J Rang Med Col. 2025 Sep;10(2): 121-127
Prolonged and Saddleback Fever in Children with Dengue: Prevalence and Severity Correlation in a Paediatric Intensive Care Unit
Background: Dengue fever remains a major global health concern, particularly in pediatric populations in endemic countries like Bangladesh. Objective: This study aimed to evaluate the prevalence of prolonged and saddleback fever patterns and their association with clinical severity and outcomes among pediatric dengue patients. Methods: This cross-sectional analytical study was conducted in the Pediatric Intensive Care Unit (PICU) of Bangladesh Shishu Hospital and Institute from August 2023 to February 2025. A total of 47 pediatric dengue patients under <18 years with confirmed infection (NS1 or IgM positive) were analyzed. Fever patterns were categorized as prolonged or biphasic (saddleback). Patients without prolonged or saddle-back fever were considered controls. Clinical presentations, laboratory parameters, complications, and outcomes were documented. Logistic and linear regression analyses were conducted to determine the association between fever pattern and disease severity. Results: Prolonged and saddleback fever groups demonstrated significantly higher complications, including hepatic involvement (OR=2.50, p=0.04) and co-infections (OR=4.21, p=0.03). Both groups exhibited pronounced thrombocytopenia (platelets <50,000/μL), hematocrit elevations (>20%), and severe coagulopathy compared to controls. Mortality was notably higher in prolonged fever (18.2%) and saddleback fever (16.7%) groups versus controls (3.3%). Logistic regression revealed prolonged fever significantly reduced the odds of clinical improvement (OR=0.13, p=0.03), while saddleback fever showed a borderline significant reduction (OR=0.22, p=0.05). Male sex (OR=1.65, p=0.05) and older age (OR=1.22, p=0.002) increased the likelihood of prolonged or saddleback fever. Conclusion: Prolonged and saddleback fever trajectories in pediatric dengue patients are associated with heightened clinical severity, increased complication risks and reduced survival. Recognition of these fever patterns could enhance early clinical risk stratification, guiding management and optimizing outcomes in pediatric dengue, particularly in resourcelimited endemic regions. J Rang Med Col. 2025 Sep;10(2): 128-134
Comparison of Early Versus Delayed Laparoscopic Cholecystectomy in Patients with Acute Calculus Cholecystitis: A Single-Centre Cross-Sectional Study
Introduction: Acute calculus cholecystitis is a frequent cause of biliary morbidity, and laparoscopic cholecystectomy is the preferred treatment. Early surgery may limit inflammation and reduce pain duration, while delayed surgery allows resolution of acute symptoms. Comparing outcomes of early versus delayed intervention is essential to guide optimal surgical timing and improve patient recovery. Objective: To compare the outcomes of early versus delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Methods: Acomparative cross-sectional study was conducted at the Department of Surgery, Sylhet Women’s Medical College Hospital from January 2023 to December 2024. A total of 86 patients were divided into two groups: early surgery (within 72 hours of symptom onset) and delayed surgery (after 72 hours, following 4-6 weeks of conservative management). Outcomes assessed included duration of surgery, complications, conversion to open surgery, hospital stay, post-operative pain, time to return to normal activities, and port site infection. Results: Early surgery was associated with shorter duration of abdominal pain (3.05 vs. 4.15 days, p<0.001), higher WBC count (p=0.003), and elevated bilirubin (p<0.001), reflecting more acute presentation. Operation time, postoperative pain, and return to normal activities were similar. Nausea, vomiting, and positive Murphy’s sign were more frequent in the early group (p<0.05). No differences were observed in complications, conversion to open surgery, or port-site infection, indicating comparable safety for both approaches. Conclusion: Early laparoscopic cholecystectomy effectively reduces pain duration and addresses acute inflammation without increasing complications, making it a safe and preferable approach for acute calculus cholecystitis. J Rang Med Col. 2025 Sep;10(2): 135-140
Analyses of the First Professional Medical Undergraduate Regional Anatomy Written Short Answer Questions of Four Public Universities of Bangladesh
Introduction: Anatomy has been a keystone subject of medical undergraduate curriculum for hundreds of years. A deep understanding of Anatomy is essential for all branches of medical science. Analysis of the assessment instrument is a good way of developing insight into what and how students are learning a particular subject. One valid way to do this must be an analysis of the question papers. Study of the question paper swould identify that how the different cognitive domains are addressed, how problem-based and other clinically-oriented knowledge of the student are assessed. Objective: To analyze the Regional Anatomy portion of the First Professional MBBS Anatomy written question papers of the last five years (January 2012 to November 2016) of the four public universities of Bangladesh for determining: the frequencies of ‘question-segment’s addressing the different levels of cognitive domains andthe frequencies of ‘problem-based’ and ‘other clinically-oriented’ ‘question-segment’s. Methods: The cross-sectional descriptive study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of March 2017 to February 2018. The study, all the ‘question-segment’s of Anatomy written question papers (only SAQ) dealing with Regional Anatomy of the First Professional MBBS Examination of the four public universities of Bangladesh of the last five years (January 2012 to November 2016) was targeted for analyzing. The frequencies of ‘question-segment’s those addressing different levels of cognitive domains(Remember, Understand, Apply, Analyze, Evaluate and Create level); ‘problem-based’ and ‘other clinically-oriented’ ‘question-segment’s were determined. Results: Most (89%) of ‘question-segment’s of the question of the question papers addressed the recall-level of the cognitive domain. 11% of ‘question-segment’ addressed the understand-level, but no ‘question-segments’ for addressing other levels of the cognitive domain could be identified. The frequency of ‘question-segment’s assessing the ‘other clinically-oriented’ question is 10.84%. No problem-based question-segments was identified. Conclusion: The result suggested that the higher levels of cognitive domains were neglected in the assessment-system and need to be addressed with appropriate weighting in the Anatomy written question papers. J Rang Med Col. 2025 Sep;10(2): 141-145
Evaluation of Smell Abnormalities after SARS- Cov-2 Infection among Field Level Health Care Providers in Bangladesh
Introduction: The SARS-CoV-2 pandemic has significantly impact on global health, with clinical presentations ranging from asymptomatic to severe, leading to complications like pneumonia, ARDS, sepsis, organ failure, and COVID-19-related deaths. Olfactory dysfunction (OD) is a prevalent symptom of COVID-19, affecting 47.9% to 70% of patients and contributing to a significant rise in global OD cases Objective: This study was aimed to evaluate the prevalence and characteristics of smell abnormalities in field-level healthcare providers in Bangladesh following SARS-CoV-2 infection. Methods: A cross-sectional descriptive was conducted at Department of ENT and Head-Neck Surgery, Ad-din Sakina women’s medical college, Jashore, Bangladesh, from January , 2022 to December, 2022 on 100 front-line health care works of various health care institutes of Bangladesh to investigate post-SARS CoV-2 smell function using integrated structured interviews and standardized olfactory test. Results: Among 100 patients, 81% demonstrated normal olfactory function. 14% developed hyposmia, 3% anosmia and one patient developed cacosmia and parosmia each. Conclusion: The study highlights the significant impact of SARS-CoV-2 on olfactory function among frontline healthcare workers in Bangladesh. The findings underscore the need for continued research and awareness regarding olfactory dysfunction, particularly among those at the frontline of healthcare. J Rang Med Col. 2025 Sep;10(2): 146-151
Evaluation of Serum Alanine Aminotransferase Level in Areca Nut Chewers
Background: Areca nut chewing is a common social tradition in many regions of the world particularly in Southeast Asia. It is one of the addictive substances that have toxic manifestations in immune, hepatic and other defense systems. Objective: To assess the effects of areca nut on liver function by serum alanine aminotransferase (ALT) level in areca nut chewers. Methods: This cross-sectional analytical study was conducted in department of Physiology, Rangpur Medical College, Rangpur from July 2022 to June 2023. Total number of 200, age range from 30 to 45 years, were selected after satisfactory inclusion and exclusion criteria. They were divided into two groups. Group A- 100 areca nut chewers, Group B-100 non areca nut chewers. Their liver function status was studied by measuring serum alanine aminotransferase level. For statistical analysis data were analyzed by students t-test, level of significance p<0.05, was performed by computer-based software SPSS-25.0 version for windows. A p-value <0.05 was accepted as level of significance. Ethical consideration was achieved by taking an informed written consent after briefing about objectives of the study. Quality was assured through avoidance of missed data, filling of code, regular entry of data and careful data analysis. Results: Mean serum ALT level was significantly (p<0.001) higher in areca nut chewers than non areca nut chewers. Conclusion: The increased serum ALT level in areca nut chewers is evidence of development of hepatic disorders due to areca nut consumption. J Rang Med Col. 2025 Sep;10(2): 152-155
Outcomes of Distal Third Tibial Shaft Fractures Treated by Modified Interlocking Intramedullary Tibial Nail
Introduction: Distal third tibial shaft fractures are challenging to manage due to poor soft tissue coverage and high risk of malalignment and delayed healing. Modified interlocking intramedullary nailing offers improved stability and early mobilization compared to conventional methods. Objective: This study aimed to evaluate the clinical, radiological, functional, and structural outcomes of distal third tibial shaft fractures treated with the modified interlocking intramedullary tibial nail. Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from July 2016 to June 2018. A total of 30 patients aged between 18 and 65 years of both sexes, presenting with distal third tibial shaft fractures (AO classification types 42A1–3 and 42B1–3) were included. Data was analyzed using the Statistical Package for Social Sciences (SPSS), version 22. Results: In this study of 30 patients with distal third tibial shaft fractures treated using a modified interlocking intramedullary tibial nail, the majority achieved radiological union within 16–18 weeks and full weight bearing by 14–16 weeks. Most patients experienced no pain, deformity, or significant motion loss, with 90% showing excellent-to-good functional recovery per the Karlström–Olerud score. Overall, the procedure provided stable fixation, rapid healing, and satisfactory functional and structural outcomes with minimal complications. Conclusion: Treatment of distal third tibial shaft fractures with the modified interlocking intramedullary tibial nail yields excellent clinical, radiological, functional, and structural outcomes with minimal complications. J Rang Med Col. 2025 Sep;10(2): 156-162
The Great Masquerader: Autoimmune Pancreatitis Presenting as an Obstructive Pancreatic Head Mass and the Avoidance of a Whipple Procedure
Autoimmune pancreatitis (AIP) is a unique, steroid-responsive focal form of chronic pancreatitis, particularly in the pancreatic head, often presents as a mass-forming lesion with obstructive jaundice, perfectly mimicking pancreatic adenocarcinoma. Distinguishing between these two entities is paramount, as their management is radically different. A 45-year-old male presented with a three-week history of painless jaundice, pruritus, and weight loss. Computed Tomography (CT) revealed a hypodense mass in the pancreatic head measuring 3.5 cm, with abrupt cutoff of the common bile duct and double-duct sign, accompanied by proximal biliary and pancreatic duct dilatation. Serum Carbohydrate Antigen 19-9 (CA 19-9) was elevated at 250 U/mL. The patient was scheduled for a pancreaticoduodenectomy (Whipple procedure). Prior to surgery, a review of the CT by a dedicated pancreatic radiologist noted a subtle "halo sign" around the pancreas. This prompted further testing, which revealed a serum IgG4 level of 650 mg/dL. A FNA cytology via ultrasonogram showed lymphoplasmacytic infiltration and >50 IgG4-positive plasma cells per high-power field, consistent with AIP Type 1. The Whipple procedure was canceled. The patient was started on oral prednisone (40 mg/day). His jaundice resolved within two weeks. A repeat CT scan after 4 weeks of therapy showed a dramatic reduction in the size of the pancreatic head mass and resolution of the biliary dilatation. CA 19-9 normalized. The steroid dose was tapered, and the patient was maintained on azathioprine. He remains asymptomatic at one-year follow-up. This case highlights that AIP must be a mandatory consideration in every patient with a suspected pancreatic head malignancy. The presence of a “halo sign” on imaging and elevated serum IgG4 is crucial diagnostic red flags. A definitive tissue diagnosis is often necessary to prevent unnecessary and morbid surgery. A high index of suspicion and a multidisciplinary approach are essential. J Rang Med Col. 2025 Sep;10(2):166-169
Precision Medicine: Global landscape and its Strategic Imperative for Bangladesh
Precision medicine (PM) is a fundamental transformation in healthcare, moving from a reactive, "one-size-fits-all" model to a proactive approach based on individual variability in genes, environment, and lifestyle. This review summarizes the global landscape of PM on its technological drivers, clinical applications, and associated ethical challenges. It then critically analyzes the nascent state of PM in Bangladesh on the existing infrastructure, formidable barriers, and potential opportunities. The article concludes with a strategic roadmap, emphasizing that for Bangladesh to employ PM's potential for its dual disease burden, a coordinated national strategy focusing on infrastructure, workforce development, and ethical governance is not just beneficial but essential. J Rang Med Col. 2025 Sep;10(2): 163-165
Key Public Health Challenges in Bangladesh: Importance to Address and Steps to Implement
Abstract not available J Rang Med Col. September 2025; Vol.10, No.2:1-2