Mymensingh medical journal : MMJ最新文献

Ovarian cancer is ranked as seventh commonest cancer and the eighth most common cause of cancer death among female worldwide. Epithelial ovarian cancer stands for the utmost deadly malignant disease of the female genital system. Usually it is diagnosed in advanced stages due to lack of clinical symptoms in the early stages. The aim of this study is to investigate the clinicopathological features and overall survival of epithelial ovarian cancer. This retrospective cohort study was conducted at the National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh. Patients admitted in the department of Gynecological Oncology, NICRH, Bangladesh from January 2018 to June 2022 with histopathological confirmed epithelial ovarian cancer were included in this study. We analyzed 59 epithelial ovarian cancer cases with median age of 45 years (range: 36.5-55.0). Most patients (83.0%) were married. Abdominal swelling (59.0%) and anorexia (52.0%) were the most common clinical symptoms. Papillary serous cyst adenocarcinoma (76.3%) was the most common histopathological type. Most patients were diagnosed at the stage IIIC (37.3%). Overall survival rates were significantly (p<0.05) higher among stage I-II compared to stage III-IV stage. The patients treated with staging laparotomy as primary treatment showed significantly (p<0.05) better overall survival than patients treated with primary debulking surgery or interval debulking surgery. Epithelial ovarian cancer remains asymptomatic for a long time. However, early detection of cancer can significantly improve overall survival and therefore early diagnosis methods for this tumor should be developed.

Artificial intelligence (AI) has revolutionized urology, offering transformative advancements in diagnostics, treatment planning and patient care. This update highlights AI applications in diagnostic imaging, benign urological conditions, uro-oncology, urologic surgeries and patient monitoring. AI algorithms including machine learning (ML) and deep learning (DL) enhance non-oncological applications include predicting ureteral stone passage (accuracy: 85%) and optimizing benign prostatic hyperplasia (BPH) management. In uro-oncology, AI predicts biochemical recurrence post-prostatectomy (accuracy: 95%) and stratifies renal cell carcinoma aggressiveness and prostate cancer detection via MRI analysis (AUC: 0.95-0.99) and improve bladder cancer diagnosis through cystoscopic image classification (sensitivity: 89.7%). Robotic surgery benefits from AI-driven precision in procedures like robot-assisted radical prostatectomy (RARP). AI enables early detection of minimal residual disease and recurrence through analysis of urinary 'liquid biopsies', while AI-based 'computational biopsy' predicts genomic markers and clinical risk scores directly from H&E-stained slides, reducing costs and turnaround time. Ethical challenges including algorithmic bias and data privacy necessitate robust governance frameworks. Future innovations, such as artificial general intelligence (AGI), federated learning, promise personalized care and autonomously diagnoses and prescribes treatments of urologic illnesses but require interdisciplinary collaborations. This review underscores AI's potential to improve outcomes while addressing limitations in data diversity and clinical integration.

A range of medical, neurological and psychiatric disorders occur more frequently in people with epilepsy than in the general population. Although psychiatric disturbances and neuropsychological impairment are widely recognizing co-morbidities associated with epilepsy, somatic comorbidities are less commonly pronounced. For this reason, studies emphasizing increased burden of somatic comorbidities in people with epilepsy are relatively sparse. Therefore, this study was designed to assess the frequency of somatic co-morbidities in epilepsy patients attending in Dhaka Medical College Hospital (DMCH), Bangladesh. This was an observational hospital-based cross-sectional study and conducted at the Epilepsy clinic, OPD and indoor in department of Neurology and indoor in department of Medicine in DMCH. Duration of the study was two and half years following ethical approval. Epilepsy patients aged ≥18 years attending in study site were approached for inclusion of the study. A total 100 epileptic patients were screened purposively and interviewed meticulously to find out the somatic comorbidities. Written informed consent was taken from each subject of both groups. Collected data were kept recorded in case record form. Finally, data analysis was done by SPSS version 23.0. Mean age of the Epilepsy patients were 34.13±14.52 (SD) years. Male to female ratio of epilepsy patients was 1.44:1. Overall presence of somatic comorbidities in epilepsy patients was 40.0%. The most common somatic co-morbidities in patients with epilepsy were HTN (10.0%) followed by DM (8.0%), PUD (8.0%) and Migraine (7.0%). Distribution of comorbidities were similar across gender except Migraine and RA, which were significantly higher among female patients (p<0.05). HTN, DM, PUD, migraine and low back pain were the most frequent somatic comorbidities identified among the epilepsy patients.

Acute appendicitis is one of the most common causes of an acute abdomen. Early recognition of the condition and prompt operation has been the most important factors in reducing morbidity and mortality. On the other hand, removing a normal appendix is a burden both on patients and health resources. Several scoring systems have been used to aid in early diagnosis of acute appendicitis and its prompt management. Recently, the Alvarado, the acute inflammatory response (AIR) and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems have been the more common clinical diagnostic scoring systems used for the diagnosis of acute appendicitis. The study was performed to identify the scoring system having best predictive values for diagnosing acute appendicitis. Objective of the study was to compare the predictive values of Alvarado, AIR and RIPASA scoring systems for diagnosing acute appendicitis. This study was conducted in the department of Surgery of Shaheed Suhrawardy Medical College & Hospital, Bangladesh from June 2020 to May 2021. A total number of one hundred (100) patients were included in the study. This study prospectively compared the RIPASA, Alvarado and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with acute appendicitis and underwent appendicectomy. Then the scores of RIPASA, Alvarado and AIR scoring systems were compared respectively. The mean age of the patients was 28.0±12.30 years with a male: female ratio of 1.08:1. Eighty nine (89) patients were positive for acute appendicitis. RIPASA scoring system had a better sensitivity (95.51%) than Alvarado (89.89%) and AIR (92.89%). Specificity was more in RIPASA (85.82%) than Alvarado (63.64%) and AIR (81.82%). Statistically significant difference (p<0.05) is found in the difference of area under curves (AUC) of Receiver Operating Characteristic (ROC) curve of RIPASA (0.960), Alvarado (0.809) and AIR (0.864) scoring systems. The study concluded that the RIPASA scoring can be effectively conducted for the better evaluation of acute appendicitis which holds promise as an improved cost effective way of diagnosis.

The object of the study was to characterize the demographic profile, clinical features and frequency of synchronous polyp in patients with colorectal cancer. This was a hospital based cross sectional analytical study among sixty colorectal cancer patients who met the selection criteria and attended in Gastroenterology, Surgery, Medicine and Radiotherapy departments of Dhaka Medical College Hospital from November 2016 to October 2017. Patient's demographic profile, clinical features, presence of synchronous polyp and histopathology of both tumour and polyp were noted. Site distributions of colorectal cancer and polyp were also noted. Comparison of clinical, demographic and pathological characteristics between synchronous polyp group and non-polyp group of colorectal cancer patients were done. Mean age was 42.40±1.64 years (range 16-75 years) and majority (38.3%) were less than 30 years. Forty-one were males (68.3%) and 19 were females (31.7%). Most frequent clinical presentations were altered bowel habit (81.7%), weight loss (78.3%), tenesmus (76.7%) and per rectal bleeding (61.7%). Significant observations (p<0.05) in left sided tumour was per rectal bleeding and blood mixed stool, where as in right sided tumour it was cramping discomfort in lower abdomen, and anaemia. Most frequent site of colorectal cancer was rectum (56.7%), followed by caecum (11.7%), ascending colon (8.3%) and transverse colon (8.3%). Left sided colorectal cancer was 66.7% and right sided was 33.3%. Histopathology showed 98.3% adenocarcinoma, and only 1.7% squamous cell carcinoma. Out of 60 cases, 11(18.3%) had synchronous polyp. Most common site of the synchronous polyp was rectum (54.5%) followed by sigmoid colon (18.2%) and transverse colon (9.1%). 18.2% patients had synchronous polyp at multiple sites. Histopathology of the synchronous polyp showed two (18.2%) tubular adenoma, another two (18.2%) tubulovillous adenoma, three (27.3%) villous adenoma and in four (36.4%) patients' histopathology of polyp was not done. Analysis of Clinical, demographic and pathological characteristics between synchronous polyp group and non-polyp group of colorectal cancer patients were unremarkable. Symptoms suggestive of colorectal cancer in young adults should not be overlooked. Synchronous polyp should be searched preoperatively in colorectal cancers. If present they should be resected for biopsy to reduce the risk of metachronous colorectal cancer.

Student selection processes in medical educational institutions vary widely across countries. This review summarizes the approaches used for selecting medical students in different national contexts and explores their relevance for the further development of the medical admission process in Bangladesh. Literature searches were conducted in Google Scholar and PubMed using keywords derived from the research question, including "medical school", "admission criteria" and "student selection". Retrieved articles were screened for relevance and organized according to country of publication. Findings from each country were then examined and compared using a narrative synthesis approach. Best practices were recommended for Bangladesh. The countries included in this review were Bangladesh, India, Pakistan, China, Nepal, Sri Lanka, Malaysia, Indonesia, Japan, the Philippines, Singapore, Taiwan, North America (the USA and Canada), the United Kingdom, Germany, Oceania (Australia, New Zealand and Fiji) and Sub-Saharan Africa (Kenya, Nigeria and South Africa). Among these settings, some countries employ centralized medical admission systems, while others utilize nationwide entrance examinations. These assessments commonly evaluate cognitive abilities, with several systems also incorporating non-cognitive domains. A small number of countries do not operate centralized admission mechanisms and primarily rely on measures of cognitive academic achievement. Overall, the findings highlight the importance of integrating both cognitive and non-cognitive criteria in medical school admissions to ensure the selection of candidates with appropriate academic competence and professional attitudes.

To develop immunity against Covid-19, vaccination was prioritized by World Health Organization (WHO). According to WHO, at least 70% of a population should be vaccinated to develop herd immunity. For this purpose, several kinds of vaccination had been introduced. One of them was Sinopharm inactivated Covid 19 vaccine, that was administered for a trial purpose to the medical students from 16th august 2021. So our purpose was to see the side effects following vaccination to sweep out the fear regarding Sinopharm vaccination. This cross-sectional analytical study was carried out from June to September 2021, among 228 medical students to find out the side effects after receiving 1st and 2nd dose of Covid-19 vaccines. Data were presented in both frequencies and percentages. Vaccine site pain was complained by 84.0% students after first dose and 78.0% students after 2nd dose. Many of the students complained of headache (49.8% after 1st dose, 38.8% after 2nd dose), fever (36.0% after 1st dose, 17.2% after 2nd dose). Some of students complained of muscle pain joint pain, which resolved within a short period. From this study; it was found that, adverse effect following 1st and 2nd dose of Sinopharm were mild, common and non-life threatening.

Dental caries is among the most common oral diseases in children, and restoring primary incisors is particularly challenging due to the need for strength, durability, and esthetics. Conventional composite restorations are widely used, while anterior strip crowns-transparent, celluloid preformed crowns- are also increasingly applied with promising esthetic outcomes. However, evidence comparing their clinical performance is limited. The study aimed to compare the clinical efficacy and parental satisfaction of anterior strip crowns with conventional composite restorations in primary anterior teeth. A randomized controlled trial was conducted in the Department of Pedodontics, Bangladesh Medical University, Bangladesh from October 2021 to September 2022. Sixty maxillary primary incisors from 28 children were included. Satisfaction of parents about color, size, shape and appearance was estimated using a Likert scale. Clinical efficacy was evaluated in terms of retention, marginal adaptation, and surface texture based on USPHS criteria at 3, 6 and 9 months. Data were analyzed using SPSS (version 26.0) with Chi-square and Independent t-tests; p<0.05 was considered significant. Of the 60 teeth, 28 were central and 32 lateral incisors. Over 9 months, no statistically significant differences (p>0.05) were found between the two groups in most criteria. After 9 months, marginal adaptation was rated "very good" in 73.3% of strip crown cases (Group A) and 60.0% of composite cases (Group B), without significant difference. Surface smoothness matched surrounding enamel in 80.0% of Group A and 50.0% of Group B, with significant differences at 3 and 9 months (p<0.05). Anterior strip crowns demonstrated higher parental satisfaction and better clinical outcomes, particularly in surface smoothness, compared to conventional composite restorations. Although most differences were not statistically significant, strip crowns appear to be a more favorable option for restoring carious primary maxillary anterior teeth.

Ovarian carcinomas are heterogeneous neoplasms associated with distinct molecular abnormalities. The P53 tumor suppressor gene plays a key role in cell cycle regulation and carcinogenesis, while Ki-67 protein serves as a marker of cellular proliferation. This study aimed to identify the types of ovarian neoplasms received, evaluate P53 and Ki-67 expression in surface epithelial carcinomas and correlate findings with tumor grading. This cross-sectional descriptive type of observational study was carried out in the Department of Pathology, Mymensingh Medical College, Bangladesh, from July 2018 to August 2019. A total of 166 specimens of ovarian tumor from patients admitted in the Department of Gynaecology and Obstetrics were included in this study. Of these, 35 cases were histopathologically diagnosed as epithelial ovarian carcinoma (EOC). All EOC specimens were processed for immunohistochemistry using P53 and Ki-67 antibodies. Demographic data, including age and diagnosis, were retrieved from requisition forms and statistical analysis was performed. The most frequent histological pattern (81.0%) was surface epithelial tumor. Among EOCs, serous carcinoma was predominant (82.0%), followed by mucinous (8.0%) and endometrioid carcinoma (2.0%). The mean age of patients was 50.69 years, with Grade 1 tumors being most common (45.7%). Immunohistochemical analysis revealed significant associations of P53 and Ki-67 expression with EOC (p=0.001). A significant correlation was observed between total histologic score and percentage of positive staining for both markers. P53 expression was strongly associated with higher histological grade (p<0.05), whereas Ki-67 showed no significant correlation with grade but correlated with total histologic score. These findings suggest that P53 expression is linked to tumor aggressiveness, while Ki-67 reflects proliferative activity without direct grade correlation. Assessment of P53 and Ki-67 may provide valuable insight into the biological behavior of epithelial ovarian carcinoma and guide treatment modification.

Haemodynamic stability is essential requirements of modern anaesthesia. Usually both propofol and isoflurane meet these criteria though the clinical effects like postoperative nausea and vomiting, after administering propofol and isoflurane have been studied in various operations. Isoflurane has a low blood gas partition coefficient, which contributes to rapid induction and emergence from anaesthesia than with other volatile anaesthetics in current clinical use. Propofol has been established as the intravenous agent that provides faster and smoother recovery and perioperative Haemodynamic stability. In this Randomized controlled trial, patients admitted for spine surgeries under general anaesthesia, at Department of Anaesthesia and ICU and Department of Neuro-Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh from January 2022 to December 2022. Patients were selected in the pre anaesthesia check up room on the basis of inclusion and exclusion criteria those were scheduled for spine surgeries under General Anaesthesia. They were divided into two groups by randomization; Group P and Group I. A written informed consent was taken from all selected patients. Patients were advised to fast for at least 8 hours before intervention. In the operating room, after preoxygenation with 100.0% O2 for three minutes, patients induced with Injection propofol (1.5 mg/kg) intravenously in both groups, intubation done with Injection succinylcholine (2mg/kg). In Group I, anaesthesia maintain with isoflurane, nitrous oxide (66.0%) and oxygen (33.0%), while in Group P it is maintain with propofol infusion, nitrous oxide (66.0%) and oxygen (33.0%). All patients are given N₂O in oxygen and 1.25% inspired concentration of Isoflurane (MAC -1.15) in Group I, while propofol infusion at rate of 80 μg/kg/min (fixed from the beginning) in Group P. All data collected at -Just after starting, 15 minute, 30 minute, 1 hour and >1 hour interval per operatively. Data was compiled, edited and plotted in tabular and figure form to evaluate the effects of isoflurane and propofol regarding hemodynamic status. Eighty (80) patients yielded the following results. The mean age of Group I and P were 34.6±12.5 years and 32.56±12.55 years. Mean difference of heart rate was lower in Group P than that of Group I. Others parameter in both groups were confined to good and acceptable categories. But interestingly, there was statistically significant difference found between Group P and Group I in SBP and DBP. The scoring was far better in Group P than Group I. Mean SBP was higher in Group I than Group P (p>0.05). Similarly, mean DBP was also higher in Group I than Group P (p>0.05). Propofol is clearly ahead to maintain hemodynamic status than Isoflurane for Spine surgery under General anaesthesia.