Bangladesh Medical Research Council Bulletin (Vol. 51, No. 02, 2025)

Bangladesh has seen a major shift from heavy dependency on agriculture to progressive industrialization and urbanization since the mid-20th century.¹ Industrial burn is such an entity that causes human tragedies or financial losses and has strong ecological, technological, and legal impacts.

Industrial burn is easy but very important to prevent. Why? Let’s answer ‘easy’ first. It’s easy because an industrial infrastructure is considered a controlled environment dwelling a homogenous group of people that is the workers. And the second issue is why it is so important. This is because the people working here, who become major victims of these incidents belong to those 47% people of in the country who are at their working age.²

A study conducted at Dhaka Medical College in the year 2022 that considered autopsy data and relevant medicolegal information of the year, and found burn is the most common cause of unnatural death (418 among 1792 cases). Among burn deaths, 55.74% were laborers, 55.98% were 21-40 years of age and 70.09% of victims were male.³ Although it is data from a medical college only, it manifests the current demographic pattern of burn injuries.

Despite progress in workplace safety regulations, burn injuries continue to cause loss of lives, long-term disabilities, absenteeism at workplaces, and social, psychological, and economic hardship.

Abstract

Background:A small but significant portion of gynecological cancers in children and teenage girls is ovarian. They are responsible for 8% of all pediatric abdominal tumors and 1% of all pediatric cancers. These tumors were assumed to be uncommon in children since ovarian cysts are believed to develop from mature follicles.

Objective: To determine the frequency, clinical features, radiological features and histological findings of various ovarian tumors in girls aged up to 19 years

Methods: This retrospective study was done at Gynecological Oncology Department of BMU from 2016 to 2023 which included females aged 0–19 years who underwent surgery for ovarian masses with confirmed histopathology. Older patients (>19 years), incomplete records, missing imaging, and non-neoplastic lesions without histology were excluded. Data from medical records, imaging (USG/MRI) report, operation notes, and histopathology reports were abstracted, and tumors were classified as benign or malignant and by WHO histological category. According to age subjects were grouped as (0–9), (10-14), and 15–19 years. We estimated the proportion of pediatric/adolescent cases among all admissions at 95% CI and tested associations between tumor behavior and age group, presentation, size, laterality, and gross morphology. Malignant cases were staged by FIGO. Analyses used chi-square or Fisher’s exact tests for categorical data and t-test or Mann Whitney U for continuous data. P-value <0.05 was regarded as significant. IRB approval was obtained; consent was waived due to the retrospective design but strict confidentiality was maintained.

Results: Among 980 overian tumour, 63 were found in pediatric and adolescent age group. Among them 33 were benign and 30 were malignant. The majority of tumors occurred in the 15–19-year age group. Among benign tumors, mature cystic teratoma (45.5%) was the most common, while dysgerminoma (40%) predominated among malignant tumors. Clinically, benign cases mostly presented with abdominal pain (63.6%), while malignant cases more often presented with abdominal lump, acute abdomen, or ascites. Radiologically, benign tumors were typically smaller (<10 cm), unilateral, and unicystic, whereas malignant tumors were more often 10–15 cm, sometimes bilateral, and frequently cystic-solid.

Conclusion: Benign overian tumors slightly outnumbered malignant tumors. Mature cystic teratoma is the most common benign tumor and dysgerminoma the leading malignancy. Benign cases usually had abdominal pain, while malignant ones often presented with mass or acute abdomen.

Keywords: Benign ovarian tumors, malignant ovarian tumor, pediatrics and adolescent age groupr

Abstract

Background:Primary care physicians (PCP) are the corner stone of non-alcoholic fatty liver disease (NAFLD) management as they are the first point where patient’s management begin. Knowledge and practice pattern of PCP reflects the overall scenario of NAFLD management in a country.

Objective:To assess the status of current Knowledge, Attitude and Practices among Primary Care Physicians of Bangladesh in regards to NAFLD.

Methods:Thi cross-sectional survey conducted from July 2023 to December 2023. About 384 registered primary care physicians (PCP) from 20 randomly selected upazila of Rangpur divisions were included in this study. A survey questionnaire in English language was developed and administered. Continuous variables were analyzed by Student’s t test, categorical variables by the Chi square test.

Results:Among 384 participant, overall 82.8% of PCP had sound knowledge(satisfactory) regarding NAFLD diagnosis and management. This study found better attitude among 81% of physicians and approximately good attitude to the remaining 19%. Most of the physician did not counsel NAFLD patients about prognosis (70%), did not manage according to existing guidelines (93.75%), did not advise about lifestyle modification (59.6%), were not confident in dealing a NAFLD patients(62.5%) and usually did not advise for follow up(50.78%) of the patients. About thirty percent of study physicians prescribe lipid lowering agents and 29.95% prescribe ursodeoxycholic acid. Whereas, only 7.55% of them prescribed Vitamin E and 4.95% prescribed pioglitazone. Association of ‘practicing year experience’ of PCP showed that, paradoxically, physicians with 10-15 years’ experience showed significantly lower guideline adherence (c2=4.67, p=0.031) and vitamin E prescription (c2=4.92, p=0.027) compared to younger colleagues. Physicians in divisional area demonstrate significantly higher screening rates (χ2=11.27, p=0.004) and treatment confidence (χ2=8.92, p=0.012) compared to rural (thana/union) practitioners. In this study, male physicians showed significantly higher metabolic screening (χ2=8.12, p=0.004) and specialist referrals (χ2=9.45, p=0.002).

Conclusion:This study revealed that our PCP have better knowledge about NAFLD. But their practices are not adequate. That’s why, continuous medical education of clinicians on current practice guidelines for NAFLD is needed

Keywords: Nonalcoholic fatty liver disease, primary care physician, knowledge, attitude and practice

Abstract

Background:Obstructed Defecation Syndrome (ODS) is a prevalent clinical condition. Stapled transanal rectal resection (STARR) is a relatively novel technique for treating this disorder. There is a paucity of evidence to support it’s safety and efficacy.

Objective: To evaluate the clinical efficacy and safety of STARR procedure in ODS due to rectal intussusception

Methods:This self control clinical trial was performed in the department of colorectal Surgery at Shaheed Suhrawardy Medical College Hospital in Dhaka over the course of one year from February 2023 to January 2024. This study involved 34 adult ODS patients due to rectal intussusception. These patients were pre operatively and post operatively evaluated for their bowel habit by Modified Longo Score. Patients with recurrent ODS or other anorectal conditions were excluded from this study. Upon obtaining consent from the participants, a standardized questionnaire was used to collect demographic and other information. Data were analyzed utilizing SPSS version 23.

Results:The average age of the patients was 46.79 ± 6.66 years. Males (67.6%) were more prevalent than females (32.4%). All patients experienced constipation. Nine patients (26.5%) experienced stomach pain, three patients (8.8%) exhibited per rectal hemorrhage, and most of the patients (83.8%) had a history of prior abdominal surgery. The average duration of hospital stay was 4.35 ± 1.53 days, with a range of 3 to 7 days. The median (range) Modified Longo Score was 14 (7 - 18) preoperatively, which was decreased to 7 (4 - 10) after 15 days, 5 (3 - 9) after 1 month, and 4 (3 - 7) after 3 months of operattion. The Modified Longo Score significantly(p<0.001) decreased after-operation. Postoperative bleeding was noted in six patients (17.6%) but were non-fatal and was managed conservatively

Conclusion:Stapled transanal rectal resection (STARR) is a safe and effective surgical intervention for Obstructed Defecation Syndrome (ODS)resulting from rectal intussusception

Keywords:Stapled transanal rectal resection (STARR), obstructed defecation syndrome, rectal Intussusception

Abstract

Background:Insulin resistance, central adiposity, and aging are key contributors to rise of prevalence of metabolic syndrome (MetS) worldwide, including in Bangladesh. Early detection of individuals at risk of MetS is crucial for prevention. The Triglyceride-Glucose (TyG) index, calculated from fasting plasma glucose (FPG) and triglyceride (TG) levels, serves as a surrogate marker for insulin resistance. Lipid Accumulation Product (LAP), calculated from waist circumference (WC) and TG levels, reflects central obesity. Therefore, TyG index & LAP may predict MetS more effectively.

Objective:To evaluate the association of TyG index and LAP with MetS in young adults of Bangladesh

Methods:This cross-sectional study was conducted at Sir Salimullah Medical College from March 2024 to February 2025. Using purposive sampling, 246 apparently healthy urban adults (18-40 years) were recruited. MetS was defined per modified NCEP-ATP III guidelines. Demographic, clinical, and biochemical data were collected. TyG index and LAP were calculated, and their associations with MetS were analyzed by unpaired t-test. Youden index was done to determine the optimal cut-off values for the TyG index and LAP in predicting MetS. Using these cut off values their diagnostic performance for prediction of MetS was determined by receiver operating characteristic (ROC) curve analysis and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was calculated. A p-value ≤0.05 was considered statistically significant.

Results:Among 246 young adults, the prevalence of metabolic syndrome (MetS) was 34.6%. Both TyG index and LAP were significantly higher in participants with MetS (p < 0.001). The optimal cut-off values were 8.69 for TyG and 39.93 for LAP. Individuals with TyG >8.69 and LAP >39.93 had increased risk of MetS. ROC analysis showed excellent diagnostic performance of TyG (sensitivity 97.6%, specificity 85.7%, PPV 78.3%, NPV 98.5%, AUC 0.962, accuracy 90.2%) and LAP (sensitivity 98.8%, specificity 77.0%, PPV 69.2%, NPV 98.6%, AUC 0.976, accuracy 84.2%) for detection of MetS.

Conclusion:High Triglyceride-Glucose (TyG) Index and raised Lipid Accumulation Product (LAP) are associated with metabolic syndrome (MetS) in young adults in Bangladesh. Both indices demonstrate high diagnostic efficacy for MetS with cutoff point 8.69 for TyG index & 39.93 for LAP, making them valuable non-invasive and cost-effective surrogate markers for identifying individuals at risk of MetS. Given their simplicity and reliability, TyG index and LAP can be utilized for early detection and screening of MetS.

Keywords:Triglyceride-Glucose Index (TyG), Lipid Accumulation Product (LAP), Metabolic Syndrome (MetS)

Abstract

Background:Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent metabolic diseases worldwide. The hemoglobin glycation index (HGI) quantifies interindividual variations in glycated hemoglobin (HbA1c), and is associated with diabetic complications, and metabolic diseases.

Objective:To evaluate the association of Hemoglobin Glycation Index (HGI) with Non-alcoholic Fatty Liver Disease (NAFLD) in Non-diabetic individuals.

Methods:This cross-sectional analytical study was conducted at Sir Salimullah Medical College from March 2024 to February 2025. This study enrolled a total of 340 non-diabetic suspected cases of NAFLD with age range of 18-65 years attending the outpatient department of Hepatology, Sir Salimullah Medical College Mitford Hospital, Dhaka. The sampling technique was purposive. Based on the ultrasonogram findings, the study subjects were categorized into two groups: NAFLD, and non-NAFLD group. Hemoglobin glycation index (HGI) was calculated by subtracting the predicted value of HbA1c from the measured HbA1c level (HGI = measured HbA1c – predicted HbA1c) for all participants. A predicted value of HbA1c was calculated by inserting fasting plasma glucose concentration into simple linear regression equation (predicted HbA1c = 0.9616 × FPG mmol/L + 0.0963). Subjects were divided into low HGI group (HGI≤median) and high HGI group (HGI>median) using the median HGI as a cut-off value (- 0.38 %). HGI was compared between NAFLD, and non-NAFLD group by chi square test. Risk of NAFLD in subjects with high HGI was calculated by odds ratio (OR). Using the median value as cut off point; performance of high HGI was determined for prediction of NAFLD with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. p value ≤0.05 was considered statistically significant.

Results:Among 340 participants, 141 study subjects (41%) were in the NAFLD group, and the rest 199 subjects (59%) belong to the non-NAFLD group. A significant association of high HGI with NAFLD (P value 0.00001) was observed, and subjects with high HGI found to have 6.85 times more risk to develop NAFLD (OR = 6.85, CI: 4.2 11.1). Receiver operating characteristics (ROC) curve analysis of high HGI (cut-off value- 0.38) for prediction of NAFLD showed area under curve (AUC) to be 0.697 and performance analysis of high HGI for detection of NAFLD showed sensitivity 63.8 %, specificity 79.8 %, PPV 75.2%, NPV 69.4% and accuracy 71.8 %

Conclusion:There is significant association (OR = 6.85) of high hemoglobin glycation index (HGI) with nonalcoholic fatty liver disease (NAFLD) in non-diabetic individuals. High hemoglobin glycation index (HGI) as a diagnostic biomarker for prediction of nonalcoholic fatty liver disease (NAFLD) is not satisfactory because of its low sensitivity, poor specificity and low area under curve (AUC).

Keywords:Hemoglobin glycation index, Non-alcoholic Fatty Liver Disease, Non-diabetic individual

Abstract

Background:Acute ischemic stroke management has advanced considerably, but still identifying a reliable biomarker to predict stroke severity and to optimize treatment remains challenging.

Objective:The objective of this study was to assess the correlation between plasma circulating cell free DNA (ccfDNA) and the severity of acute ischemic stroke based on National Institutes of Health Stroke Scale (NIHSS) score.

Methods:This cross-sectional study was carried out from March 2023 to January 2024, at the department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh. A total 36 patients with ischemic stroke were selected based on clinical and neuroradiological findings within 72 hours of the event. At the time of admission, a clinical assessment was conducted using the NIHSS score. After extracting the ccfDNA from plasma it’s purity and the quantity was initially observed using a Nanodrop spectrophotometer. Finally, to validate the extraction and quantification process, ccfDNA was again measured using TaqMan-based real-time PCR targeting the beta globin gene, where the cycle threshold values were converted to kilogenome equivalents per liter.

Results:Patients with higher NIHSS score had larger amounts of ccfDNA (p-value <0.05). Additionally, a strong positive correlation (r = 0.643; p<0.05) was observed between the NIHSS score and the amount of ccfDNA following ischemic stroke.

Conclusion:Plasma ccfDNA level progressively rises with the severity of damage in acute ischemic stroke

Keywords:Circulating cell free DNA (ccfDNA), acute ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score, stroke severity

Abstract

Reproductive tissue cryopreservation is done for fertility preservation (FP), which is a critical aspect of cancer survivorship, especially for children, adolescents, and young adults undergoing gonadotoxic treatments such as chemotherapy and radiotherapy. Preserving reproductive potential has become more crucial as cancer survival rates have increased. However, obstacles to FP make it challenging to use and implement, especially in environments with limited resources.

This review aims to examine the effects of cancer treatments on reproduction, the FP procedures that are available for both male and female patients, the difficulties in making FP decisions, and the obstacles to putting FP strategies into practice in settings with limited resources.

Fertility is greatly impacted by chemotherapy and radiation, with pelvic radiation and alkylating drugs presenting the most significant hazards. Male tissue freezing include sperm cryopreservation from ejaculated semen and testicular sperm or tissue in case of azoospermia. Techniques for females include cryopreservation of oocytes, embryos, and ovarian tissue. A multidisciplinary approach involving oncologists, reproductive specialists, and psychosocial support teams are necessary to enhance fertility preservation (FP) accessibility. However, implementing FP opportunities in low-resource settings is challenging due to several barriers.

Due to cultural preconceptions, exorbitant prices, a lack of medical knowledge, and limited awareness, the acceptance of FP remains low despite advancements. In low-resource settings, financial constraints, inadequate infrastructure, and insufficient training of healthcare professionals further exacerbate FP access issues. Barriers to FP at the patient, provider, health system, and societal levels were identified, along with potential remedies.

Establishing oncofertility patient navigation systems, integrating FP discussions into oncology care, and creating financial support programs can facilitate informed FP decisions and improve implementation in low-resource settings.

Keywords: Cancer Survivors, Chemoradiation, Fertility Preservation, Low-Resource Settings

Abstract

Congenital coronary artery anomaly (CAA) is a rare entity. Recognition and precise detection of the CAA is essential for correct management of the condition. Various diagnostic techniques can be used to detect CAA and to assess the presence of high-risk features associated with CAA. Coronary computed tomography angiography (CCTA) is currently considered the gold standard test for diagnosing CAA and cardiac magnetic resonance (CMR) is considered as an alternative but both the techniques are expensive and not widely available in every corner of our country. Transthoracic echocardiography (TTE) is regarded as a key tool in the detection & diagnostic workup of CAAs in children, in whom the optimal acoustic windows usually allow the visualization of coronary ostia and there is no risk of radiation exposure. In adults, TTE plays a minor role in detecting CAA because here TTE can’t identify coronary ostia clearly. Moreover, in adults it is difficult to visualize the course of coronary artery & it’s relations with the great vessels by TTE. In spite of all limitations; in some adult cases, identification of two signs in TTE can predict anomalous origin of coronary artery (AOCA). These two signs are “RAC sign” (retro aortic anomalous coronary) and “Crossed aorta sign”. Therefore, visualization of RAC sign & /or “Crossed aorta sign” in TTE can predict the presence of anomalous origin of left circumflex coronary artery (LCX). In this middle-aged woman while performing TTE, we found these two signs (RAC sign & Crossed aorta sign) and predicted her to have anomalous origin of LCX. Subsequently coronary angiogram (CAG) confirmed the diagnosis. So, careful echocardiographic observation may alert the interventional cardiologist to pay special attention during coronary catheterization to find out AOCA.

Keywords: Anomalous origin of left circumflex artery (LCX), crossed aorta sign, retro aortic anomalous coronary (RAC)