Bangladesh Medical Research Council Bulletin (Vol. 51, No. 01, 2025)

Hemorrhagic Cystitis (HC), a distressing complication arising after chemotherapy, significantly impairs patients’ quality of daily life and can lead to substantial morbidity and mortality.¹ This condition, characterized by inflammation and bleeding of the bladder lining, presents a considerable challenge in clinical management, particularly in cases where conventional treatments prove ineffective.² In the search for more effective therapeutic strategies, Hyperbaric Oxygen Therapy (HBOT) has emerged as a promising non invasive or minimally invasive modality. While HBOT has displayed potential in managing HC, especially that induced by radiation, it’s role in treating chemotherapy- induced HC is gaining increasing attention.³

Abstract

Background:Higher postoperative morbidity and longer hospital stay are linked to diabetes insipidus (DI) after surgery of sellar or suprasellar tumors

Objective: To find out the predictors of postoperative DI following sellar or suprasellar surgery

Methods: This case-control study was conducted at the National Institute of Neurosciences and Hospital, Dhaka, from January to June 2023. Patients with sellar or suprasellar tumors admitted to the neurosurgery department for surgery were included by non-probability consecutive sampling (n=109, age 39.4±13.7 years, 44.9% female). All patients were treated surgically by standard protocol. A standard institutional inpatient monitoring system was used in all postoperative patients regardless of symptoms, including hourly intake and output measurements. Participants were followed up regularly during their hospital stay and then after 6 weeks of surgery up to 6 months. Specific criteria were used to confirm the diagnosis of DI for each patient. All clinical and laboratory data were recorded in a data sheet. Finally patients developing DI were grouped as case and rest of them grouped as control. All clinical and laboratory parameters were compared between two groups.

Results: Transient DI (resolved within 6 weeks of surgery) was present in 53 (49%) and prolonged DI (persisted >6 weeks of surgery) in 22 (20%) participants. Transient DI were more frequent in participants with 1st postoperative serum sodium level >145 mmol/L (p<0.001). Participants with younger age (p=0.044), non pituitary sellar tumor (p=0.044), preoperative hypothyroidism (p=0.048), gross total removal of tumor (p=0.027) and 1st postoperative serum sodium level >145 mmol/L (p<0.001) had higher frequency of prolonged DI. However, in logistic regression, preoperative hypothyroidism (OR 3.4; 95% CI 1.0-11.6; p=0.048) and 1st post operative serum sodium >145 mmol/l (OR 11.4; 95% CI 2.8-46.4; p<0.001) showed a significant association with prolonged DI when adjusted for age, tumor type, route and extent of resection.

Conclusion: First post-operative serum sodium >145 mmol/L is a significant predictor of transient DI; whereas first post-operative serum sodium >145 mmol/L and preoperative hypothyroidism are found to show significant predictivity on prolonged DI.

Keywords: Diabetes insipidus, sellar tumor, suprasellar tumor

Abstract

Background:Prolonged screen time (time spent on digital devices) among children has become a global concern due to its detrimental effects on their development and behavior.

Objective: This study investigated the adverse effects of prolonged screen time in children.

Methods:A cross-sectional survey was conducted among 153 parents from Defence Services Command and Staff College, Mirpur Cantonment, Dhaka; who had at least one child aged 1 to 12 years. Data were collected during August to October 2022 from the parents about their children’s developmental and behavioral issues by using a self-administered questionnaire. Statistical analysis included descriptive methods and the Chi-square test, with a significance threshold of p- value d” 0.05.

Results: The mean age of the participants (parents) was 32.99 ± 3.49 years, with a majority being women (66%). Female parents and parents who were homemaker or had higher educational background, more likely reported their children to be on excessive screen time. In 56% of the cases, no adverse developmental or behavioral issues were observed. Parents identified speech delay (17%), aggressive behavior (13%), poor communication (9%), hyperactivity (7%), screen addiction for feeding (7%), vision problems (4%), inattention to study (4%) and sleep disturbances (3%) as common adverse effects of excess screen time exposure in their children. Aggressive behavior, poor communication, dependence on screens during feeding were found strongly associated with prolonged screen time (e”2hr per day) use in children. Children of most participants (87%) had access to smartphones, with 52% usage reported for recreational purpose

Conclusion: The growing prevalence of excessive screen use among children in Bangladesh is associated with various developmental (speech delay and poor communication) and behavioral challenges (aggressive behavior, hyperactivity, screen dependency for feeding, visual & sleep disturbance, inattention to study). Parents should play the pivotal role in managing screen time to mitigate these negative outcomes

Keywords: Screen time, children, developmental, behavioral

Abstract

Background:Renal stones commonly occur in the lower calyx, making treatment challenging due to anatomical factors. The main treatment options for lower calyceal stones are extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). ESWL is preferred for stone <1cm, while PCNL for stone >2cm. However, for 1-2 cm stone with favorable lower pole calyceal anatomy, both treatments are practiced. ESWL is non-invasive with fewer complications but has lower stone clearance requiring multiple sessions. PCNL has higher stone clearance but more complications. So, choosing the best treatment option in this debatable situation need evidence based comparative studies.

Objective:To evaluate efficacy and safety of PCNL compared to ESWL in treating lower calyceal renal stone of 1-2 cm in favorable lower pole calyceal anatomy

Methods: This was a single center hospital based quasi-experimental study on patients with unilateral, single, radiopaque, 1-2 cm sized lower calyceal renal stone in favorable lower pole calyx anatomy; from January,2023 to August,2024 in the Department of Urology, Bangladesh Medical University (BMU), Shahbag, Dhaka. CT urogram was carried out to assess the favorable infundibular characteristics, stone size, Hounsfield unit and skin to stone distance. Experimental group underwent PCNL and control group, ESWL. Operation duration, post operative complications determined by modified Clavien Dindo, duration of hospital stay and stone clearance were evaluated between the groups. Continuous variables were analyzed by t-test and categorical variables by chi-square test and fisher’s exact test. P-value <0.05 was considered statistically significant.

Results:With 22 patients in each group, control group had longer operation time (70.23±23.73 minutes) compared to experimental group (65±13.54 minutes); but the difference was not statistically significant (p=0.374). Grade 1 complication was more in control group than experimental group. While grade-2 complication was more in experimental group than control group but overall complication rate was identical (P=0.763) between two groups. Duration of hospital stay was significantly shorter (P<0.01) in control group (11.09±3.89 hours) than experimental group (77.45±22.13 hours). Stone clearance was significantly (P=0.012) higher in experimental group (81.1%) than control group (45%).

Conclusion:PCNL offers better stone clearance but require longer hospital stay than ESWL with identical operative duration and complication rates between them.

Keywords: Lower calyx stone, 1-2 cm renal stone, Favorable lower pole anatomy, Percutaneous nephrolithotomy, Extracorporeal shock wave lithotripsy.

Abstract

Background:Paracrine effect of the epicardial adipose tissue promotes coronary atherosclerosis. Epicardial adipose tissue is the main determinant of interatrial septum thickness (IST) and it is also a true marker of cardiac adiposity. The relationship of interatrial septal thickness as a marker cardiac adiposity with severity of coronary artery disease (CAD) is not thoroughly investigated in our population

Objective:This study was conducted to evaluate the association of interatrial septal thickness (IST) with severity of coronary artery disease.

Methods: In this cross-sectional study, a total of 100 patients with CAD who agreed to undergo coronary angiography were included by non-probability sampling. Coronary angiogram was done during index hospital admission. Interatrial septal thickness was measured using bidimensional echocardiography. Coronary artery severity assessed by Gensini score. On the basis of IST, study subjects were divided into two groups: 50 patients of CAD with ISTe”14.2 mm were designated as Group I (Thick) and 50 patients of CAD with IST<14.2 mm were designated as Group II (Thin). Clinical (age, sex, smoking habit, hypertension and diabetes mellitus, as well as presentation of CAD) and anthropometric (waist circumference and body mass index) variables were also collected.

Results:Severe CAD patients were found significantly more in Group I (thick) than in Group II (thin) [78% vs 14%, P<0.001]. IST showed a moderate positive correlation with Gensini score (r=0.58). Univariate and multivariate analysis revealed that dyslipidemia, diabetes mellitus, high waist circumference and increased IST were independently significant predictors of severe CAD. Out of them increased IST was found be the strongest independent predictor of the severity of CAD with OR 9.8.

Conclusion:The study demonstrated that increased interatrial septal thickness (IST) is associated with severe coronary artery disease. So severe coronary artery disease can be predicted by echocardiographic measurement of interatrial septal thickness.

Keywords:Interatrial septal thickness, coronary artery disease, cardiac adiposity

Abstract

Background:Diabetes mellitus (DM) and its associated complication is getting a big concern day by day around the whole world including Bangladesh. Fasting plasma glucose (FPG),2hour post load plasma glucose (2hPG) and glycated hemoglobin (HbA1C) are commonly used to diagnose diabetes mellitus (DM) but there is disparity and discordance among the results of these three diagnostic tools.

Objective:Our aim was to address the issue of concordance and discordance among the three diagnostic tools (FPG, 2hPG,HbA1C) of diabetes mellitus.

Methods:This cross sectional analytical study was conducted among the individuals attending for screening of diabetes mellitus to outpatient department of endocrinology, Bangladesh Medical University (BMU), Dhaka during the period of March 2019 to February 2020.A total 1165 subjects were recruited by non-probability sampling technique. Individuals were identified as diabetic by positivity of any of the three tools (FPG,2hPG and HbA1C) and individuals were regarded as nondiabetic by negativity of all three tools. Frequency of diabetes were compared among these tools to determine their concordance(agreement) or discordance(disagreement) by Kappa test. Data were analyzed using SPSS.

Results: This study shows that; out of 1165 study subjects, 339(29%) were diabetic by any tool positivity and 826(71%) were non diabetic by all three tools negativity. The frequency of diabetes was found 15.9% detected by FPG, 21.2% by 2hPG and 23.2% by HbA1C. Here, 2hPG and HbA1C detected almost similar number of diabetic population but FPG underestimates this diagnosis significantly. In agreement test, all three diagnostic tools showed merely good agreement with the lowest kappa value, which was not satisfactory from clinical point of view. In case of missed diagnosis; FPG alone missed 45.5%, 2hPG 27.0% and HbA1c 20.0% of diabetic patients. Here the rate of missed diagnosis by HbA1c is less as it reflects the long term glycemic control.

Conclusion:DM detection rate was found highest by use of HbA1C and lowest by FPG; on the other hand, FPG showed highest missed diagnosis and HbA1C showed the lowest. No clinically satisfactory agreement (concordance) was found among the three diagnostic tools (FPG,2hPG and HbA1C) for diagnosis of DM.

Keywords:Diabetes mellitus, Fasting plasma glucose, 2hour post load plasma glucose, HbA1C, Concordance, Discordance

Abstract

Background:Endometrial carcinoma is influenced by estrogen and progesterone. So, expression of their receptors play pivotal roles in tumor pathogenesis and therapeutic response.

Objective:Hormonal receptor expression is linked to tumor differentiation and response to hormone therapy. This study aimed to evaluate the expression of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor2 (HER2) in endometrial carcinoma and their correlations with histological type, grade, and FIGO surgical stage, to identify endometrial carcinoma patients expected to be potentially benefitted from hormone therapy.

Methods:This cross-sectional study included 31 histologically confirmed cases of endometrial carcinoma. Clinicopathological data were collected, and immunohistochemistry was performed to assess ER, PR, and HER2 expression. Chi square tests were used to evaluate associations of receptor expression with tumor characteristics and disease staging.

Results:The mean age of patients was 57.87 ± 8.91 years, with 45.2% aged e”60 years. Endometrioid adenocarcinoma (58.06%) was the most common subtype, and deep myometrial invasion was observed in 54.8% cases. ER and PR positivity rates were 51.6% and 48.4%, respectively, with their significant co-expression (P <0.001). Both markers were strongly associated with histological type I and histological grade 2 endometrial carcinoma but showed no significant correlation with its FIGO surgical stage. HER2 expression was rare (3.2%) in endometrial carcinoma.

Conclusion:In endometrial carcinoma, good number of patients express ER and PR with their significant co expression. ER and PR expression are significantly associated with favorable histological types I and histological grade II; suggesting their (ER, PR) potential as biomarkers for clinical decision regarding hormone therapy in endometrial carcinoma.

Keywords:Endometrial carcinoma, Estrogen receptor, Progesterone receptor, Human Epidermal Growth factor Receptor2, Hormone therapy.

Abstract

Background:Solitary thyroid nodules are common in general population; most being asymptomatic and detected only through imaging. The main clinical concern was their potential risk of malignancy as thyroid cancer incidence had significantly increased over recent decades. Ultrasonography, the preferred imaging modality provides detailed structural information. In contrast, thyroid scintigraphy categorizes nodules based on functional status. The American College of Radiology has proposed Thyroid Imaging Reporting and Data System (TIRADS) that enhances ultrasound’s ability to stratify malignancy risk, offering a structured approach to management decisions in solitary thyroid nodules.

Objective:To compare diagnostic performance of ultrasound TIRADS and thyroid scintigraphy for detection of malignancy in patients with solitary thyroid nodule.

Methods:This cross-sectional study was carried out in the Department of Radiology and Imaging at Dhaka Medical College Hospital and the Institute of Nuclear Medicine and Allied Sciences, Dhaka. A total of 74 adult patients with solitary thyroid nodule were included in this study. In all patients both ultrasound TIRADS and thyroid scintigraphy were done to evaluate the characteristics of the nodule. Patients were operated for nodule and postoperative biopsy was done for histopathology in each patient. Results of both ultrasound TIRADS and thyroid scintigraphic findings were compared with that of histopathology to determine their diagnostic performance for malignancy detection with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.

Results:The mean age of the participants was 43.5 ± 11.0 years, with a higher frequency of females (64.9%). Based on TIRADS classification, 36.5% of nodules were categorized as malignant (TIRADS 4-5). Thyroid scintigraphy findings showed that 81.1% of nodules were cold (malignant). Histopathological analysis confirmed 20.3% of nodules as malignant. TIRADS demonstrated higher sensitivity (93.3%), specificity (77.97%), PPV (51.85%), NPV (97.87%) and accuracy (81.08%) in detecting malignancy compared to thyroid scintigraphy (sensitivity 66.67%, specificity 15.25%, PPV 16.67%, NPV 64.29% and accuracy 25.68%).

Conclusion:This study demonstrates that ultrasound TIRADS is a more reliable imaging modality than thyroid scintigraphy for detection of malignancy in solitary thyroid nodules with significantly higher sensitivity, specificity, PPV, NPV and accuracy. While thyroid scintigraphy remains useful for functional assessment; its limited specificity makes it less effective for malignancy detection.

Keywords:Solitary thyroid nodule, ACR-TIRADS, thyroid scintigraphy