Bangladesh Medical Research Council Bulletin (Vol. 52, No. 02, 2026)

Stroke is the third leading cause of death in Bangladesh, with a national prevalence of approximately 11.39 per 1,000 people, posing a huge economic and healthcare burden on the country.¹ It is a major public health issue that causes high prevalence of long-term health impairment and loss of productivity. Geographical disparities, cultural practices, limited patient awareness, and institutional limitations in healthcare infrastructure are the main causes of disparities in secondary stroke prevention in Bangladesh. Acute stroke survival rates have increased nationwide, but preventing a recurrent event which makes up almost one-third of hospitalized stroke cases in Bangladesh remains extremely in bad shape.²

Although risk factors are well established, peoples rarely understands their (risk factor) precise relationship to a recurrent stroke.² Major modifiable risk factors like hypertension (78%), smoking (72%), diabetes (56%), and dyslipidemia are systematically undertreated due to socioeconomic and institutional barriers.³ Vulnerable groups are at a high risk of recurrent strokes due to significant differences in secondary stroke prevention in Bangladesh, which are mainly caused by severe infrastructural limitations, medication non-adherence, economic inequality, and deep urban-rural gaps.⁴ While acute stroke therapy concentrates on immediate survival, secondary prevention uses medication management, lifestyle modifications, and ongoing risk-factor control to prevent a second occurrence. However, nationwide access to these life-saving procedures is hindered by systemic issues.^2,5

Abstract

Background:Among several biomarkers Ki-67 and KRAS are two significant biomarkers providing information of biological behavior of ovarian cancer and targeted therapies. In this study the expressions status of Ki-67 and KRAS were assessed and correlated with each other and with the cancer-related characteristics.

Objective:The aim of this study was to assess and correlate the expressions of Ki-67 and KRAS in ovarian cancer patients and analyze the expressions with cancer-related characteristics of the patients.

Methods:In this cross-sectional analytical study 30 formalin-fixed paraffin-embedded (FFPE) ovarian cancer tissue blocks and 20 FFPE non-cancerous ovarian tissue blocks were collected and immunohistochemical staining for Ki-67 and KRAS expressions in these tissue sections were done. Cancer-related information of the patients were collected. Immunohistochemical staining for Ki-67 and KRAS were analyzed to assess the expression in ovarian cancer tissues and to observe the association of their expressions with each other and with the cancer-related characteristics.

Results: Expression of Ki-67 was significantly high in cancerous than non-cancerous ovarian tissues and Ki 67 index was ≥20% in 60% of ovarian cancer tissue. KRAS was expressed in 20% of ovarian cancer tissues and none of the non-cancerous ovarian tissues. Statistically significant association was found between the positive expression of KRAS with pelvic organs and lymph nodes involvement. Expression of Ki-67 and KRAS also significantly associated with each other.

Conclusion: Ki-67 was highly expressed in ovarian cancer tissue than non-cancerous ovarian tissue and Ki 67 expression was significantly associated with KRAS expression. KRAS expression is significantly associated with pelvic organs and lymph nodes metastases. So, these two markers can be new biomarkers for assessing biological behaviour and progression.

Keywords:Ovarian cancer, Ki-67, KRAS, Immunohistochemistry

Abstract

Background:Temperature is a major factor affecting the quality of plastination. The present study was conducted to explore a suitable method for plastination in Bangladesh by comparing the effect of cold and room temperatures on the tendon flexibility throughout the plastination.

Objective:The objective of the study is to compare the percentage of change in flexibility of cow’s tendon in silicone (S10) plastination at cold temperature with those at room temperature.

Methods:An experimental study was performed at Bangabandhu Sheikh Mujib Medical University (BSMMU) currently known as Bangladesh Medical University, Dhaka, Bangladesh. Forty (40) pieces of tendon were obtained from approximately one-year-old cows (Bos indicus) slaughtered at a government-authorized slaughterhouse in Dhaka, Bangladesh, following international animal sacrificing protocols. Ethical clearance was obtained from the Institutional Review Board BSMMU. The specimens of tendon were divided equally into two groups: twenty (20) processed at cold temperature and the other twenty (20) at room temperature. Then the percentage of change in flexibility was measured at every stage of plastination: fixation, dehydration, forced impregnation and gas-curing and then compared between two temperature groups. The overall percentage of change in flexibility from fixation to gas-curing was also measured.

Results:The percentage of change in tendon flexibility was smaller (yielding greater flexibility) at cold temperature (29.56 ± 12.60) than at room temperature (30.47 ± 9.96) during fixation, although difference was not statistically significant (p = 0.787). However during dehydration, the change in flexibility of tendon was larger (yielding lesser flexibility) at cold temperature (49.46 ± 16.62) than at room temperature (45.43 ± 15.97), but the difference was also not significant (p = 0.433). The percentage of change in tendon flexibility was smaller (yielding greater flexibility) at cold temperature (42.43 ± 22.44) than at room temperature (45.18 ± 15.94) during forced impregnation, although difference was not statistically significant (p = 0.499). Moreover, the percentage of change in tendon flexibility was smaller (yielding greater flexibility) at cold temperature (29.81 ± 14.89) than at room temperature (39.14 ± 19.53) during gas-curing, which is reasonably close to the significant level (p = 0.062). The overall change in flexibility of pieces of tendon was smaller (yielding greater flexibility) at cold temperature (84.01 ± 8.22) than at room temperature (88.07 ± 5.27), with a reasonably close to the significant level (p = 0.074).

Conclusion:The cold temperature plastination showed consistent changes towards better preservation than room temperature across all stages of the process but was not statistically significant. The near significant results of gas-curing and overall flexibility indicates cold temperature palstination may show better outcome to preserve the properties of tendons..But, Further research with larger sample sizes is recommended to confirm these results.

Keywords: Plastination; tendonflexibility; Silicone (S10) method; temperature; preservation

Abstract

Background: The choice of skin closure technique influences closure time postoperative pain and wound cosmetic outcome following laparoscopic surgery. Tissue glue has emerged as an alternative to skin staples, but comparative evidence remains limited.

Objective:To compare tissue glue and staples with respect to skin closure time, postoperative pain, and wound cosmesis in elective laparoscopic surgery.

Methods:This quasi-experimental study was conducted in the Department of General Surgery at Bangladesh Medical University, from October 2023 to September 2024. Sixty patients undergoing elective laparoscopic surgery were allocated in two groups: the experimental group (Group A-tissue glue; n=30) and the control group (Group B-skin staples; n=30). Skin closure time was recorded in minutes. Postoperative pain was assessed using the Visual Analog Scale at 12, 24, 48, and 72 hours and on postoperative day 7. Wound cosmesis was evaluated on postoperative day 7 and at 01 (one) month. Data were analyzed using SPSS version 27.

Results: The mean skin closure time was significantly shorter in the tissue glue group compared to the stapler group (3.90 ± 0.72 vs. 5.60 ± 1.46 minutes; p=0.001). Postoperative pain scores were significantly lower in the tissue glue group at 12, 24, 48, and 72 hours (p<0.05), with no significant difference on postoperative day 7 (p=0.087). Wound cosmesis scores were significantly better in the tissue glue group on postoperative day 7 and at 01 (one) month (p=0.001).

Conclusion: Tissue glue results in significantly better outcomes than skin staples for skin closure in elective laparoscopic surgery.

Keywords: Tissue glue; Staples; Laparoscopic surgery

Abstract

Background:Although effective in controlling malignancy, radiotherapy can adversely affect surrounding normal tissues, particularly the oral cavity. Radiation-induced changes in hard and soft tissues may compromise periodontal health and negatively influence patients’ quality of life.

Objective:This study aimed to evaluate the effect of head and neck radiotherapy on periodontal tissues and to assess changes in periodontal parameters and oral hygiene status in patients undergoing radiotherapy.

Methods: A one sample cohort study was conducted among 40 patients diagnosed with head and neck cancer who were scheduled for radiotherapy. Demographic characteristics, including age, sex, and personal habits (smoking, tobacco use, alcohol consumption, and betel quid chewing), were recorded. Periodontal parameters assessed were Plaque Index (PI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Bleeding on Probing (BOP). Baseline measurements of PI, PPD, CAL and BOP were taken before radiotherapy and a, follow up evaluations was done at 1 month, 2 months, and 6 months after radiotherapy. Statistical analysis was performed to compare changes in mean periodontal parameters over time.

Results: At 1 month post-radiotherapy, a statistically significant increase in PI (p < 0.001) was observed, while changes in PPD and CAL were not statistically significant. At 2 months, both PI and PPD showed significant increases (p < 0.001), whereas CAL remained statistically unchanged. By 6 months, significant increases were observed in all periodontal parameters, including PI, PPD, and CAL (p < 0.001), compared to baseline values. Regarding BOP, 37.5% of patients presented with bleeding at baseline. This increased to 52.5% at 1 month and 55.0% at 3 months post-radiotherapy. However, at 6 months, the proportion of patients exhibiting BOP decreased, with 72.5% showing no signs of bleeding on probing.

Conclusion:Radiotherapy for head and neck malignancies significantly affects periodontal health over time, leading to progressive increases in PI, PPD, and CAL. These findings highlight the importance of comprehensive oral assessment and appropriate periodontal management before and during radiotherapy to minimize complications and improve overall treatment outcomes.

Keywords:Head and neck neoplasm; radiotherapy; periodontal parameters

Abstract

Background:Knee is the most complex joint and prone to injury. Ligament and meniscal injuries are common and a major cause of morbidity. Accurate diagnosis requires clinical history, examination and imaging. Magnetic resonance imaging (MRI) is the non invasive gold standard for detecting knee injuries, but ultrasonography (USG) is emerging as a cost-effective, non-invasive and dynamic alternative.

Objective:To evaluate role of sonographic assessment of internal derangements of knee joint in comparison to Magnetic Resonance Imaging.

Methods:A Cross sectional study of 61 patients with knee joint pathology underwent USG & MRI for the diagnosis of internal derangements of knee joint between the period of October 2022 to September 2024 was conducted in Department of Radiology and Imaging, BIRDEM General Hospital, Dhaka, Bangladesh. Procedure details were recorded on specifically designed pro-forma.

Results:A total of 61 patients (62.3% male; mean age 40 years) were included, with the 21–30-year age group most commonly affected. Right-knee involvement predominated (62.3%). The most frequent pathology identified by both USG and MRI was knee joint effusion (90.2% and 93.4%, respectively). Ultrasound showed good diagnostic performance overall, with good sensitivity and specificity for medial collateral ligament (MCL) tear, lateral collateral ligament (LCL) tear, and baker’s cyst, and good accuracy for anterior cruciate ligament (ACL ) tear, posterior cruciate ligament (PCL) tear, and patellar tendinopathy.

Conclusion:Knee USG is highly accurate in diagnosing joint effusion, patellar tendinopathy, posterior cruciate ligament tear, medial collateral ligament tear, medial meniscal tear, lateral collateral ligament tear, osteophytes and baker’s cyst. MRI should be reserved for patients with inconclusive USG results. Therefore, USG should be used as the first-line modality for detecting knee pathologies.

Keywords: Ligaments; Menisci; Joint effusion; Baker’s cyst.

Abstract

Background:Early identification of pregnant women at high risk for developing preeclampsia by measuring placental growth factor (PlGF) and uterine artery pulsatility index (UtA PI) levels could allow for earlier definite management and could potentially reduce the risk of complications of preeclampsia.

Objective:This study aimed to assess the efficacy of serum placental growth factor (PlGF) and uterine artery pulsatility index (UtA PI) as predictors for preeclampsia.

Methods:This prospective cohort study was conducted in the Department of Fetomaternal Medicine of Bangladesh Medical University (BMU) from November 2021 to October 2022. A total of 63 singleton pregnant women were enrolled purposively at 20-24 weeks of gestation. At enrolment UtA PI and serum PlGF were measured in each study subject. All the subject were then followed up till delivery for development of preeclampsia. The PI (pulsality index) was measured using uterine artery Doppler and the placental growth factor (PlGF) level was estimated from blood samples using ELISA. Uterine artery pulsatility index more than 95th percentile and serum placental growth factor less than 100 pg/mL were considered the baseline cut-off values using the Youden Index. In this study pregnant women having UtA PI above 95th percentile and PlGF below 100 pg/ml at enrolment were predicted to develop preeclampsia. The diagnostic efficacy of UtA PI and PlGF alone and in combination were determined for prediction of preeclampsia.

Results:Among the study subject 46% were estimated to have low serum PlGF levels and 26.9% had an increase in UtA-PI at 20-24 weeks of pregnancy. Subsequent follow-ups revealed the development of pre eclampsia (PE) in 12(19%) patients. Patients with preeclampsia had significantly lower serum PlGF levels (80.8±58.8 pg/mL) compared to those without PE (206.2±162 pg/mL, p=0.011). UtA-PI was higher in patients with preeclampsia compared to those without PE (1.5±0.4 vs. 0.9±0.18, p<0.001). Low PlGF levels increased the risk of preeclampsia 12.9 times (p<0.001), while elevated UtA-PI raised the risk 29.8 times (p<0.001). Above four fifths (83.3%) of PE group of patients had combination of low PIGF and elevated UTA-PI while it was absent in majority (90.2%) of the women with no preeclampsia. The elevated UtA-PI with combination of low PlGF strengthens the predictive values for preeclampsia with reported sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of 83.3%, 90.2%, 66.7%, 95.8%, and 88.9% respectively.

Conclusion:The combination of PlGF and UtA-PI is a good tool for predicting the development of preeclampsia.

Keywords: Placental growth factor (PIGF); uterine artery pulsatility index (UtA-PI); Preeclampsia

Abstract

Cerebral venous sinus thrombosis (CVST) in itself is a rarely encountered clinical entity, and its association with immune thrombocytopenic purpura (ITP) makes it a more unusual presentation. Here we reported a young patient of known ITP presented with sudden severe headache, convulsion and weakness of left side of the body. The case was thoroughly evaluated clinically, and then the diagnosis was made by clinical presentation along with raised D-dimer and magnetic resonance venography (MRV) of brain findings supportive of CVST. Though rare, a suspicion of cerebral venous sinus thrombosis should be considered in a patients with known ITP with features of raised intracranial pressure and focal neurological deficit. Concomitant occurrence of bleeding disorder and thrombosis is challenging to treat. But appropriate diagnosis and early intervention can save the patient.

Keywords: Cerebral venous sinus thrombosis; Immune Thrombocytopenic Purpura; D-dimer; Magnetic resonance venograhy