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Febuxostat and Renal Outcomes in Stage 3-4 CKD Patients with Asymptomatic Hyperuricemia: A Prospective Observational Study
Background: Chronic kidney disease (CKD) is commonly accompanied by asymptomatic hyperuricemia, which has been linked to faster renal deterioration. Objective: This study evaluated whether febuxostat provides renal benefit compared with standard care in adults with stage 3–4 CKD and elevated serum uric acid. Methods: This prospective observational study was conducted in the Department of Nephrology at the National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, from February to July 2016, on 150 adults with chronic kidney disease (CKD) Stage 3-4 and asymptomatic hyperuricemia (serum uric acid ≥7 mg/dL), allocated in equal numbers by a closed-envelope technique to either a Febuxostat group (40 mg once daily after breakfast) or a conventional-therapy group receiving standard CKD care without Febuxostat (75 patients in each group). Participants were followed at baseline, 2 months, and 4 months with repeat clinical and biochemical assessments. The primary outcome was a ≥10% decline from baseline eGFR at 4 months. Secondary outcomes included between-group differences in CKD stage distribution, mean eGFR, and serum creatinine at 2 and 4 months, change in serum uric acid, and significant adverse events (myocardial infarction, stroke, heart failure, mortality). Results: Over four months, febuxostat was associated with better preservation of kidney function: eGFR remained higher, creatinine rose more slowly, and progression to CKD stage 5 was markedly lower. The primary endpoint, a ≥10% eGFR decline, occurred far less frequently with febuxostat, corresponding to a substantially reduced adjusted risk. Serum uric acid decreased to near-target levels, and cardiovascular events were infrequent and comparable between groups. Conclusion: These findings indicate the short-term renoprotective potential of febuxostat in selected CKD patients, underscoring the need for longer controlled trials. J Rang Med Col. March 2026; Vol.11, No.1: 3-8
First Acute Myocardial Infarction (AMI) in the Very Young Versus Older Population: A Clinical and Prognostic Comparison
Background: South Asians, including Bangladeshis, experience AMI at younger age, yet local comparative data are limited. Objective: This study aimed to compare the very young (≤30 years) versus older (≥50 years) patients presenting with their first AMI. Methods: This cross-sectional comparative study was conducted at Dhaka Medical College and Hospital from July 2022 to December 2023, including 160 first-AMI patients, very young (n=80) and older (n=80), diagnosed by the Fourth Universal Definition (2018). Results: Mean age was 26.4±2.8 vs 61.7±7.4 years; male predominance was higher in the very young (87.5% vs 75.0%, p=0.048). Very young patients had more smoking (57.5% vs 30.0%, p<0.001) and family history (42.5% vs 20.0%, p=0.003), while older patients had more hypertension, diabetes, and dyslipidaemia (all p<0.05). STEMI, higher LVEF, and single-vessel disease were more frequent in the very young, whereas triple-vessel disease was more common in older patients. Older patients had longer stays and higher heart failure, shock, and mortality (all p<0.05). Conclusion: Very young first-AMI patients showed a smoking-dominant, single-vessel pattern with better in-hospital outcomes; older patients had cardiometabolic risk clustering, multivessel disease, and worse prognosis. J Rang Med Col.2026 Mar;11(1): 9-15
Associations Between Socio-Economic Factors and Prevalence of Shigella Infection: An Analysis of Isolated Cases
Background: Shigella infection is a major contributor to childhood diarrhoea, particularly in settings where socio-economic and environmental disadvantages limit access to safe water, sanitation, and healthcare. Objective: This study assessed the association between socio-economic factors and Shigella prevalence among isolated paediatric cases. Methods: A hospital-based observational study was conducted from July 2021 to June 2022 in the Paediatrics inpatient department of Sylhet MAG Osmani Medical College Hospital. Ninety-eight children aged ≥6 months with diarrhoea and no recent antibiotic exposure were enrolled. Stool samples underwent culture, biochemical testing, and PCR confirmation.Associations were analysed using SPSS, with significance set at p<0.05. Results: Shigella species were isolated in 13 of 98 children (13.3%), predominantly among those aged 1–5 years and from lower socio-economic backgrounds, although age, gender and socio-economic class showed no significant associations. Conclusion: Shigella infection persists in disadvantaged socio-economic settings, underscoring the need for targeted preventive measures. J Rang Med Col.2026 Mar;11(1): 16-20
Arthroscopic Evaluation Followed by Reconstruction of Both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) Injuries
Background: Knee ligament injuries involving combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) lead to substantial instability, often affecting young, active individuals following high-energy trauma. Objective: This study aimed to evaluate the outcomes of arthroscopic assessment followed by reconstruction of both the ACL and PCL in patients with combined knee ligament injuries. Methods: This prospective observational study was conducted at the Nilphamari Medical College, from July 2024 to June, 2025. All 80 patients aged 18-50 years had MRI-confirmed combined injuries and underwent standardized arthroscopic techniques using hamstring or alternative grafts. Functional improvement was assessed at 3, 6, and 12 months. Results: Most patients were men, primarily injured in road traffic accidents, and arthroscopy frequently revealed associated meniscal and cartilage lesions. By 12 months, Lysholm, IKDC, and Tegner scores improved significantly, with high overall satisfaction and a substantial return to sports. Complications remained modest, mainly arthrofibrosis and residual instability. Conclusion: Arthroscopic reconstruction yielded strong short-term recovery and functional restoration when combined with timely surgery and structured rehabilitation. J Rang Med Col.2026 Mar;11(1): 21-26
Viral Skin Infections in Diabetes: Age, Socioeconomic, and Glycemic Correlates in a Bangladeshi Cohort
Background: Diabetes mellitus increases susceptibility to viral skin infections through impaired immunity, yet evidence from low-income settings is scarce. Objective: This study examined demographic, socioeconomic, and glycemic correlates of viral skin infections among diabetic patients in Bangladesh. Methods: This cross-sectional study was conducted among 173 diabetic patients with clinically confirmed viral skin infections at the Department of Dermatology, BIRDEM General Hospital, Dhaka, Bangladesh from June 2024 to July 2025. Demographic variables, socioeconomic status (SES), environmental exposures, and glycemic control were analyzed. Results: Young adults constituted the largest group (45.7%), and males predominated (64.2%). Uncontrolled glycemia was observed in 46.2% of cases. Lower SES was strongly associated with herpes zoster (61.3%) and genital herpes (61.0%). Multivariable analysis identified low SES (aOR 2.60, 95% CI 1.40–4.85), uncontrolled diabetes (aOR 2.25, 95% CI 1.20–4.25), slum residence (aOR 2.35), and jail confinement (aOR 2.50) as independent predictors. Conclusion: Viral skin infections in diabetic patients are shaped by socioeconomic vulnerability and poor glycemic control. J Rang Med Col. 2026 Mar;11(1): 27-32
Post Tonsillectomy Secondary Haemorrhage Cold Versus Hot Method
Background: Tonsillectomy is a frequently performed otolaryngological procedure for recurrent infections or obstructive symptoms. The surgical technique may affect bleeding risk. Objective: The study aimed to compare post-tonsillectomy secondary haemorrhage incold versus hot tonsillectomy techniques. Methods: This prospective study was conducted at an otolaryngology unit in North Bengal Medical College & Hospital, Sirajganj, Bangladesh on 90 consecutive patients underwent tonsillectomy or adenotonsillectomy, from January, 2023 to December, 2023, 45 by cold steel dissection and 45 by hot electrosurgical technique. Baseline factors and preoperative Hb and platelet counts were recorded. Results: Both groups were comparable in demographics and baseline clinical factors, including indication, recent URTI, NSAID exposure, hemoglobin, and platelet count (all p>0.05). Haemostasis differed significantly: ties were used more in the cold group (48.9% vs 13.3%) and bipolar diathermy more in the hot group (75.6% vs 40.0%) (p<0.001). Operative time was similar, but blood loss was lower with the hot technique (median 26 vs 43 mL, p<0.001). Conclusion: Hot tonsillectomy significantly reduced intraoperative blood loss with similar primary haemorrhage, but showed a higher, non-significant trend toward secondary haemorrhage and related interventions compared with cold dissection. J Rang Med Col. 2026 Mar;11(1): 33-38
Comparison of Hemodynamic Stability and Adverse Effects of Carbetocin versus Oxytocin During Cesarean Delivery
Background: Postpartum hemorrhage is a significant cause of maternal morbidity, and optimizing uterotonic use during cesarean delivery is critical. Objective: This study compared hemodynamic stability and the adverse effects of carbetocin versus oxytocin. Methods: An observational study was conducted in the Department of Obstetrics and Gynaecology at BGC Trust Medical College Hospital, Chittagong, Bangladesh, over six months from January to June 2022 among 100 women undergoing cesarean section, divided into a carbetocin group (100 μg IV bolus) and an oxytocin group (10 IU IV infusion). Hemodynamic changes, estimated blood loss, need for additional uterotonics, and adverse effects were evaluated. Results: Baseline characteristics were similar across groups. Mean blood loss was lower with carbetocin (630±225 mL) than oxytocin (685±267 mL), though not statistically significant. Additional uterotonics were required less frequently with carbetocin (12% versus 28%). Adverse effects were mild and comparable, with no serious complications. Conclusion: Carbetocin provides hemodynamic stability and reduces the need for additional uterotonics, making it an effective alternative to oxytocin, especially in resource-limited settings. J Rang Med Col.2026 Mar;11(1): 39-44
Association of ACR with Serum Creatinine in Diabetic Patients in a Secondary Hospital of Bangladesh
Background: Albuminuria and serum creatinine are key markers of diabetic kidney involvement, yet their relationship in routine secondary-care settings in Bangladesh is not well characterized. Objective: This study aimed to evaluate the association between albumin-to-creatinine ratio (ACR) and serum creatinine among diabetic patients. Methods: This cross-sectional study was conducted among 70 diabetic patients at Bangladesh Institute of Health Sciences (BIHS) General Hospital, Dhaka, from July 2024 to June 2025. Spot urine ACR, serum creatinine, fasting blood sugar, and post-breakfast blood sugar were analyzed using standard cut-offs and appropriate comparative tests. Results: Mean ACR was 655.75±1023.99 mg/g, and mean serum creatinine was 1.32±0.49 mg/dL. Moderately increased ACR was observed in 50.0% and severely increased ACR in 40.0%, while 44.3% had elevated creatinine (>1.3 mg/dL). Although the ACR category was not significantly associated with creatinine status (p=0.067), serum creatinine rose significantly across ACR categories (p=0.001). Glycaemic parameters showed no significant differences by creatinine status. Conclusion: Routine ACR screening alongside creatinine may improve early DKD detection in secondary care. J Rang Med Col.2026 Mar;11(1): 45-50
Assessment of Pulmonary Function Using Spirometry in Patients with Diabetes Mellitus: A Cross-Sectional Comparative Study
Background: Diabetes mellitus (DM) is a long-term metabolic disease that is becoming more common around the world. Its systemic complications affect more than just the usual target organs. However, pulmonary involvement in diabetes is still not well understood in everyday clinical practice. Objective: To evaluate pulmonary function via spirometry in patients with diabetes mellitus and to investigate the correlation between lung function deterioration and disease duration. Methods: A cross-sectional comparative study was performed from June to November 2013 at Rajshahi Medical College Hospital and Rajshahi Diabetic Association General Hospital in Bangladesh. There were 88 participants who did not smoke and were not obese. They had type 1 DM, type 2 DM, or were matched with non-diabetic controls. Spirometry was used to measure pulmonary function (FVC, FEV_, FEV_/FVC), and SPSS version 16.0 was used to look at the data. Results: Both type 1 and type 2 diabetic patients showed a significant drop in FVC and FEV_ (measured and % predicted) when compared to controls (p<0.01). The FEV_/FVC ratio stayed the same or went up, which means that the breathing pattern was mostly restrictive. Every person with type 1 diabetes and about 78–79% of people with type 2 diabetes had FVC values that were less than 80% of what was expected. A longer duration of diabetes (>10 years) was significantly correlated with greater decreases in FVC and FEV_ (r=−0.48, p=0.002). Conclusion: Diabetes mellitus, especially of extended duration, is linked to considerable restrictive pulmonary dysfunction, underscoring the lungs as a critical target organ in diabetes. J Rang Med Col.2026 Mar;11(1): 51-56
Frequency and Severity of Drooling in Children with Cerebral Palsy– A Cross-Sectional Study
Background: Drooling is a common problem in children with cerebral palsy (CP), which has both physical and psychological impacts. So, this problem should be addressed among the CP patients. Objective: The aim of this study was to find out the frequency and severity of drooling in children with Cerebral palsy. Methods: This was a cross-sectional study conducted in the Pediatric Neurology outpatient department of the National Institute of Neurosciences and Hospital (NINS), Dhaka, from January to December 2022. A total of 100 children aged 3–14 years with a primary diagnosis of cerebral palsy who had drooling were included. The severity and frequency of drooling were assessed by Thomas Stonell and the Greenberg drooling rating scale. This Scale was used to measure the drooling severity and frequency. Data were collected via a structured questionnaire and analyzed using SPSS (version 25), with p<0.05 considered statistically significant. Ethical approval was obtained, and informed consent was secured from parents/caregivers. Results: Among the 100 participants, 54% were male and 46% were female, and about half of them were under five years of age. Spastic quadriplegia was the most prevalent CP type (45%), followed by spastic hemiplegia (30%), diplegia (19%), and dyskinetic CP (6%). Constant (42.2%) and frequent (37.8%) drooling were observed predominantly in children with spastic quadriplegia (p=0.007). In terms of severity, severe drooling was most common (74.2%), followed by profuse (50%) and moderate drooling (34.7%) in quadriplegic CP children (p=0.001), then diplegic and hemiplegic children. Conclusion: This study highlighted that the drooling frequency and severity both had a significant association with the types of CP. J Rang Med Col.2026 Mar;11(1): 57-62
Doppler Echocardiographic Hemodynamic Changes Following Percutaneous Balloon Mitral Valvotomy
Background: Rheumatic mitral stenosis is a major cardiovascular burden in poorer nations, causing increasing hemodynamic compromise. Percutaneous balloon mitral valvotomy (PBMV) has emerged as the preferred treatment for symptomatic mitral stenosis with a healthy valve shape. Objective: This study aimed to assess the doppler echocardiographic hemodynamic changes following PBMV in individuals with rheumatic mitral stenosis. Methods: This prospective observational analysis comprised 24 patients with severe rheumatic mitral stenosis who received PBMV between January and July 2021 at the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh. Patients aged 21-50 years with a Wilkins score ≤10 were enrolled. Transthoracic doppler echocardiography was performed 24 hours before and 24-48 hours after PBMV to measure peak transmitral pressure gradient, mean transmitral pressure gradient, and pulmonary artery systolic pressure. A paired Student's t-test was used for statistical analysis, with a significance level of p≤0.05. Results: The study cohort was largely female (70.8%), with a mean age range of 21-50 years. All patients complained of shortness of breath, and additional prevalent symptoms included palpitation (87.5%) and paroxysmal nocturnal dyspnea (83.33%). After PBMV, peak transmitral pressure gradient decreased from 18.04±5.23 mmHg to 12.42±5.87 mmHg (31.2% reduction, p=0.0001), mean transmitral pressure gradient decreased from 10.75±3.15 mmHg to 7.04±4.53 mmHg (34.5% reduction, p=0.0001), and pulmonary artery systolic pressure decreased from 33.50±17.41 mmHg to 25.63±13.83 mmHg (23.5% reduction, p=0.003). Conclusion: In individuals with rheumatic mitral stenosis, PBMV immediately improves doppler hemodynamic parameters such as transmitral pressure gradients and pulmonary artery pressure. These data show PBMV's efficacy in improving hemodynamic outcomes and support its use as the recommended strategy for appropriate patients with mitral stenosis. J Rang Med Col.2026 Mar;11(1): 63-68
Comparison of Serum Calcium Level Among Patients with Different Stages of Hypoxic Ischaemic Encephalopathy Due to Perinatal Asphyxia
Background: Perinatal asphyxia is a leading cause of neonatal hospital admission, particularly in low- and middle-income countries. It causes diminished oxygen supply to brain resulting hypoxic ischaemic encephalopathy with three distinct stages. Higher HIE grades have been associated with reduced calcium levels. This emergency condition can lead to multi-organ dysfunction and can affect the neonatal calcium profile causing mainly hypocalcemia. Objective: To compare the serum calcium level among different stages of Hypoxic ischaemic encephalopathy (HIE) in perinatal asphyxia Methods: This cross-sectional observational study was conducted in department of Paediatrics, Rangpur medical college hospital on 212 neonates with perinatal asphyxia with different stages of HIE. Results: Among 212 neonates birth asphyxia was predominant in male (56.5%). Birth asphyxia was predominant in vaginal delivery (64%). Majority of the neonates were in HIE stage II (58.5%) followed by stage III (21.7%) and stage I (19.8%). Serum calcium level was significantly lower in stage III to stage-II HIE (5.1±1.66 vs 6.1±1.1.54, p-value=0.0003) and stage II to stage-I (6.1±1.1.54 vs 7.2±1.35, p-value=.0003). Conclusion: Serum calcium level tends to decrease in asphyxiated neonate which is most subjacent in HIE stage III. J Rang Med Col.2026 Mar;11(1): 69-72
Arthroscopic Meniscectomy Versus Meniscal Repair: A Comparative Functional Outcome Study
Background: Meniscal tears are among the most common knee injuries, leading to pain, swelling, and functional limitations that can significantly affect daily activities and athletic performance. Objective: This study aimed to evaluate and compare the functional outcomes of arthroscopic partial meniscectomy and meniscal repair using validated clinical scoring systems. Methods: This prospective comparative study was conducted at the Department of Orthopaedic Surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from July 2024 to June 2025 on 64 patients diagnosed with symptomatic meniscal tears requiring surgical intervention divided into two equal groups: arthroscopic partial meniscectomy (n=32) and meniscal repair (n=32). Patients were followed up at 3, 6, and 12 months postoperatively, and final functional outcomes were assessed using the same scoring systems applied preoperatively. Data were analyzed using SPSS version 25.0. Results: Preoperative IKDC, Lysholm, and Tegner scores were comparable between groups. At final follow-up, the repair group achieved higher mean IKDC (85.9 vs 78.4, p-value=<0.001), Lysholm (90.4 vs 82.6, p-value=<0.001), and Tegner (6.3 vs 5.1, p-value=0.002) scores. Excellent functional outcomes were observed in 62.5% of repair patients versus 37.5% of meniscectomy patients. Complications were low in both groups, with slightly higher reoperation rates in the repair group (9.4% vs 3.1%). Conclusion: Although both arthroscopic partial meniscectomy and meniscal repair lead to significant improvements in knee function for patients with meniscal tears,meniscal repair provides superior functional outcomes, higher activity levels, and a greater proportion of excellent results at final follow-up. J Rang Med Col.2026 Mar;11(1): 73-77
Short Term Neurocognitive and Behavioral Outcome of Acute CNS Infection in Children in a Tertiary Neurology Hospital
Background: Acute central nervous system (CNS) infections remain a major cause of childhood morbidity and mortality worldwide. Although neurocognitive and behavioral sequelae are well recognized, data from Bangladesh are limited. Objective: This study evaluated short-term neurocognitive and behavioral outcomes among children hospitalized with acute CNS infections. Methods: A prospective cohort study was conducted in the Paediatric Neurology Department at the National Institute of Neuroscience and Hospital from July 2021 to June 2022 on 120 children with acute CNS infections. Demographic data, clinical features, neurological status, and neurocognitive and behavioral performance were assessed at discharge, 1–2 weeks, and 3 months post-discharge using structured questionnaires. Data were analyzed with SPSS 24. Results: The mean age was 6.3±4.3 years, with male predominance (71.7%); most children were from rural areas. Nearly half presented within one week of symptom onset, commonly with seizures (60.8%), fever (55%), Kering’s sign (50.8%), and neck rigidity (41.6%). Encephalitis (50%) and meningitis (42.5%) were the predominant diagnoses, with Streptococcus pneumoniae and Neisseria meningitidis frequently identified. More than half had stage-II disease on admission. Moderate clinical outcomes were observed in 56.6% at discharge. Motor deficits were common in encephalitis, while seizures predominated in meningitis. Disease severity was strongly associated with final clinical outcome (p<0.001), and hospital stay varied significantly by infection type (p<0.001). Neurocognitive and behavioral scores were mostly impaired at baseline but improved across follow-ups. Disease severity did not significantly influence cognitive trajectories. Behavioral outcomes at discharge differed by disease stage (p=0.020) and were associated with clinical outcomes. Logistic regression showed no independent effect of meningitis, encephalitis, or hospital stay on cognitive or behavioral outcomes. Conclusion: Encephalitis and meningitis were the leading CNS infections, with most children experiencing moderate clinical improvement by discharge. Although disease severity predicted clinical outcomes, neither infection type nor hospital stay reliably predicted neurocognitive or behavioral recovery. Younger children showed poorer baseline functioning, but substantial improvement was observed over time. Clinical outcome at discharge emerged as the strongest correlation of short-term cognitive and behavioral progress. J Rang Med Col.2026 Mar;11(1): 78-84
Prescribing Antibiotics Among Post-operative Patients in Obstetrics and Gynecology Department of Two Tertiary Care Hospitals of Bangladesh
Background: Antibiotics are important in obstetrics and gynecology for preventing and treating infections, inappropriate use contributes to antimicrobial resistance. Objective: To evaluate the prescribing pattern of the antibiotics in postoperative patients admitted in gynaecology and obstetrics at Dhaka Medical College Hospital (DMCH) and Rangpur Medical College Hospital (RpMCH). Methods: This cross-sectional observational study was carried out among the post-operative patients admitted in Obstetrics and Gynecology Departments of Dhaka Medical College Hospital & Rangpur Medical College Hospital from July 2017 to June, 2018. A total of 500 sample; 250 from Dhaka center (DMCH) and 250 from Rangpur center (RpMCH), was enrolled through purposive sampling. Sociodemographic data of the participants, diagnosis, number of prescriptions containing antibiotic, numberof antibiotic per prescription, name of drugs in generic or in trade name were recorded. Results: Among 500 subjects, 250 were from gynaecological cases and 250 from obstetrical cases. The average age was29.88±11.29 years (range: 18-70 years), with most participants (56.6%) from rural areas. Among 3978 prescribed drugs, average number of drugs per prescription was 7.91±1.49 with 28.43 % being antibiotics. 34.23% drugs were prescribed by generic names and hospital supplied drugs were 39.64%. After surgery, 72.6% of patients received two injectable antibiotics, with higher rates in Dhaka (77.2%) compared to Rangpur (68%). The average number of injectable antibiotics was similar in both centers (2.17±0.48), but oral antibiotics were more common in Dhaka (2.22±0.48 vs 2.03±0.8). Most used injectable antibiotic was ceftriaxone (Dhaka center vs Rangpur center, 88.8%, vs 82.4%) and metronidazole (Dhaka center vs Rangpur center 95.2% vs 55.6%), while cefixime(Dhaka center vs Rangpur center 64% vs 44.4%) and metronidazole (Dhaka center vs Rangpur center 82.8% vs 22.8%) were the most common oral antibiotics at discharge. Conclusion: Ceftriaxone and Metronidazole were frequently administered to postoperative patients. This indicates a trend of polypharmacy that could be reduced by selecting broad-spectrum antibiotics after culture and sensitivity. J Rang Med Col.2026 Mar;11(1): 85-91
Analyzing The Challenges and Opportunities Related to Biomedical Waste Management in District-Level Hospitals
Background: Effective biomedical waste management is crucial for safeguarding healthcare personnel, patients, and the environment from the dangers posed by toxic hospital waste. District-level hospitals in Bangladesh continue to have difficulties in establishing efficient waste management systems. Objective: This study aimed to examine the difficulties and opportunities associated with biomedical waste management practices among healthcare professionals in designated district-level hospitals in Bangladesh. Methods: A descriptive cross-sectional study was performed from March 2025 to November 2025 in designated district-level hospitals in Bangladesh. A total of 130 healthcare practitioners, encompassing physicians, nurses, custodians, and administrators, engaged in the study. Data were gathered through structured questionnaires and analysed using SPSS version 26. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were employed. Results: A moderate level of awareness of biomedical waste management among healthcare professionals was observed. Approximately 73.1% were cognizant of BWM regulations, and 60% had undergone training. Nonetheless, fewer than 50% continuously implemented waste segregation at the source. Incineration (26.9%) was the predominant treatment modality. Significant issues comprised insufficient staff awareness or training (26.9%), poor infrastructure (23.1%), and deficient monitoring (19.2%). Participants recommended consistent training, enhanced infrastructure, sufficient PPE provision, and increased oversight to improve biomedical waste management methods in hospitals. Conclusion: Results from this study suggested enchaining training, infrastructure, and proper supervision is essential to improve biomedical waste management in district levels hospitals to mitigate the health and environmental hazards in Bangladesh. J Rang Med Col.2026 Mar;11(1): 92-98
Early Enteral Feeding Strategies and Risk of Necrotizing Enterocolitis in Preterm Neonates: A Cohort Study
Background: Necrotizing enterocolitis (NEC) is a serious inflammatory bowel disease that affects preterm newborns. It has a high rate of illness and death, especially in babies who are very low birth weight. Objective: To assess the correlation between exclusive human milk (EHM) feeding in the initial 14 days of life and the incidence of necrotizing enterocolitis (NEC) in preterm neonates. Methods: A prospective cohort study was conducted Bangladesh Shishu Hospital & Institute, Dhaka involving 95 preterm neonates (<37 weeks). The neonates were categorized into two groups: EHM and non-EHM. Feeding habits, probiotic use, parenteral nutrition, and clinical outcomes were recorded. NEC incidence (Bell stage II/III), late-onset sepsis, time to full feeds, and mortality were analyzed using risk ratios, Kaplan–Meier survival analysis, and multivariable Poisson regression. Results: Neonates who were fed EHM started eating earlier, took longer to finish their meals, and used more probiotics. The rate of NEC was lower in the EHM group (5.2%) than in the non-EHM group (18.9%; RR=3.65, 95% CI 1.01–13.16, p=0.041). Feeding without EHM, being born very early, and quickly moving up the feeding schedule all raised the risk of NEC. On the other hand, antenatal steroids and probiotics were protective. EHM babies also had fewer cases of late-onset sepsis, got full feeds faster, and lived longer. Conclusion: Feeding only human milk to preterm neonates for the first 14 days greatly lowers the risk of NEC and improves clinical outcomes. J Rang Med Col.2026 Mar;11(1): 99-104
Emerging Role of COL10A1 in Breast Cancer Pathogenesis and its Potential as a Clinical Biomarker
Background: Breast cancer is a leading malignancy worldwide, with high morbidity and mortality among women. Despite advances in therapy, metastasis, recurrence, and resistance remain challenges. Collagen type X alpha-1 (COL10A1) is normally expressed in cartilage but is increasingly implicated in tumorigenesis. Overexpression of COL10A1 in breast cancer correlates with higher grade, invasiveness, and poor prognosis. Objective: To evaluate COL10A1 expression in breast cancer and its association with tumor characteristics, receptor status, and potential biomarker utility. Methods: A hospital-based cross-sectional study was conducted at department of Surgery, Dhaka Medical College Hospital from July 2022 to June 2023, including 40 breast cancer patients. Data on demographics, clinical features, and reproductive history were collected, and tissue samples were analyzed for COL10A1 expression. Inclusion required histopathological confirmed breast cancer in women _40 years. Statistical analysis used SPSS for frequencies, percentages, means, and chi-square tests. Ethical approval and informed consent were obtained, ensuring confidentiality and voluntary participation. Results: The study of 40 breast cancer patients revealed a mean age of 47.41 years. The majority had invasive ductal carcinoma (70%), Grade II (50%) or III (35%) tumors, and hormone-sensitive disease (60% ER-positive, 50% PR-positive). HER2-positivity was 25%. Critically, 80% exhibited moderate-to-high COL10A1 expression, which was strongly associated with high-grade tumors, as 10 of 14 Grade III patients showed high expression. Conclusion: COL10A1 overexpression correlates with aggressive breast cancer, highlighting its potential as a prognostic biomarker. J Rang Med Col.2026 Mar;11(1): 105-110
Socio-demographic Determinants of Appropriate Utilization of Oral Rehydration Solution Therapy in Under Five Children with Acute Watery Diarrhoea: A Hospital Based Study
Background: Acute watery diarrhea (AWD) continues to be a primary cause of morbidity and mortality in children under five. Oral rehydration solution (ORS) is a simple and affordable technique demonstrated to minimize the complications and death associated with dehydration. Objective: The effective use of ORS is frequently affected by parental socio-demographic factors. Methods: The cross-sectional study was carried out at the Department of Paediatrics, Jalalabad Ragib - Rabeya Medical College Hospital (JRRMCH), Sylhet. All children under the age of 5 years with AWD admitted to the paediatrics ward comprised the study population. Among them, a total of 300 children were selected with purposive sampling. The duration of the study was 6 months. A questionnaire was used to collect data on the sociodemographic characteristics of the study population, as well as maternal knowledge and practices regarding oral rehydration solution (ORS) and their impact on appropriate utilization of ORS were documented. Results: Most of the mothers (67%) correctly prepared ORS but only 54.3% utilized it appropriately. Among the 300 children, most of them belonged to 1 to 2 years of age group and male children were affected by diarrhoea more (61.7%), but inappropriate utilization of ORS was also predominant in male children (p <0.05). Most of the mothers were in 20 to 30 years of age (75%), resided in rural areas (77%) and were home makers (95.3%). Parents with higher education and better financial condition were associated with improved utilization of ORS (p<0.05). Fathers having business or in service were found utilizing ORS more efficiently than farmers (p <0.05). Apart from sociodemographic factors, maternal knowledge regarding ORS also influenced appropriate use of it. More than 97% of mothers knew about ORS while only 10.7% accurately knew its purpose of replacing salt and water and this group had used ORS significantly better than other groups. Approximately half of the mothers were advised by doctors and good number of them used ORS appropriately (p<0.05). Only 48 % of mothers knew the preservation time of ORS. Majority of the mothers (38%) used cup- spoon for providing ORS to their children, and 75.3% mothers also took ORS along with their children. Food restriction was also a common practice during diarrhoealillness including both babies (59.7%) and mothers (45.7%). Conclusion: This study showed that most of the mothers were familiar with ORS and its preparation. There were several factors which influenced the appropriate utilization of ORS including gender, parental education, monthly income, source of information and knowledge regarding function of ORS. J Rang Med Col.2026 Mar;11(1): 111-118
Demographic and Renal Histopathological Profile of Rapidly Progressive Glomerulonephritis in Children
Background: Rapidly progressive glomerulonephritis (RPGN) is an uncommon but severe pediatric renal disorder, and its incidence and etiological patterns remain poorly defined. Objective: This study examined demographic features and renal histopathology among affected children. Methods: A prospective observational study was conducted in the Department of Paediatric Nephrology, BICH and Dhaka Shishu Hospital from July 2018 to June 2020, enrolling 28 pediatric cases displaying features of rapidly progressive glomerulonephritisthrough non-probability sampling. Results: The mean age was 9.1±1.9 years in children with more than 50% crescents and 8.7±2.2 years in those with fewer crescents. Males predominated in the high-crescent group, and most participants (82%) were from rural areas. Increased cellularity, mesangial expansion, and interstitial inflammation were frequent in both histological categories. Most children presented with acute kidney injury stage 3, with no significant difference between groups. Conclusion: RPGN in children appears to predominantly affect rural male patients in late childhood, with severe renal dysfunction and similar histopathological patterns across crescentic categories. J Rang Med Col.2026 Mar;11(1): 119-123
Acid Fly or Paederus Dermatitis Among Foreign Medical Students Residing in Institutional Hostels in Rangpur, Bangladesh
Background: Paederus dermatitis is a form of irritant contact dermatitis triggered by pederin, a toxin released when rove beetles are crushed against the skin. Outbreaks of this condition are frequently observed in residential institutions, particularly during rainy seasons. Objective: The study utilized line-listing to summarize cases by person, place, and time, supplemented by environmental walk-through assessments to identify risk factors. Methods: We performed a descriptive cross-sectional study of an outbreak among foreign medical students residing in three hostels at Rangpur Community Medical College (RCMC) in Bangladesh, covering the period from January to December 2025. Results: A total of 76 clinical cases and 79 attack episodes were identified. The majority of affected students were Nepalese (34/76) and Indian (33/76), and female students accounted for 40 of the 76 cases. Clustering was evident at the room level, with 13 rooms reporting two or more cases, and 91.1% (72/79) of attack episodes occurred during the monsoon months of July and August. Among 74 cases with available risk-factor data, the most frequently documented associated factors were seasonal occurrence during the monsoon (72/74, 97.3%), sleeping with windows open (59/74, 79.7%), shared exposure within rooms (49/74, 66.2%), crushing the insect on the skin (48/74, 64.9%), and bed placement near windows (42/74, 56.8%). Conclusion: The outbreak demonstrated strong seasonality and room-level clustering. Preventing future occurrences requires synchronized environmental management and student awareness strategies intensified during the monsoon. J Rang Med Col.2026 Mar;11(1): 124-129
Proteinuria as a Marker of Cochlear Microvascular Damage and Functional Hearing Deficit in Presbycusis: A Cross-Sectional Study
Background: Presbycusis is the most prevalent sensory deficit in older adults, its metabolic subtype involves progressive strial microvascular degeneration. Proteinuria, a systemic marker of endothelial dysfunction, may reflect parallel cochlear microvascular damage. Objective: To investigate the association between proteinuria and cochlear dysfunction in elderly patients with presbycusis. Methods: In this cross-sectional study, 340 adults aged ≥60 years with clinically confirmed presbycusis were enrolled and classified by proteinuria status (urine albumin-creatinine ratio [ACR] ≥30 mg/g). The Hearing Handicap Inventory for the Elderly–Screening Version (HHIE-S) and the Absolute Bone Conduction (ABC) test were used to assess functional hearing deficit. Results: Of 340 participants, 112 (32.9%) had proteinuria. The proteinuria group showed significantly higher mean HHIE-S scores (20.4±8.6 vs. 8.2±6.4; p<0.001) and a greater prevalence of markedly reduced ABC results (42.9% vs. 14.0%; p<0.001). A moderately strong positive correlation was found between ACR and HHIE-S scores (r=0.58, p<0.001). Conclusion: Proteinuria is strongly associated with cochlear dysfunction and functional hearing handicap in presbycusis, supporting a shared renal–cochlear microvascular pathology. J Rang Med Col.2026 Mar;11(1): 130-135
Reconstruction of Soft Tissue Defect with Exposed Spine by Latissimus Dorsi Myocutaneous Flap–reconstructive Challenge and our Experience
Background: Reconstructive surgeons face challenges when repairing soft tissue defects with exposed spine due to the curved contour and strong skin tension of the back. Implant and metal exposure complicates coverage, and patients are often malnourished and fragile. Objective: The purpose of this study was to share our experience regarding reconstruction of soft tissue defects with exposed spine using Latissimus dorsi (LD) myocutaneous flap. Methods: This was a prospective observational study, conducted in the Burn & Plastic Surgery department of Rangpur medical college hospital, Rangpur over a period of three years July 2019 to June 2022. Here 15 patients with soft tissue defect in posterior midline with exposed spine were reconstructed with Pedicled Latissimus dorsi (LD) flap. Patient demographics, clinical details, reconstructive procedures, outcome, and complications were analyzed. Results: Among 15 patients, 12 were male and 03 were females, with male to female ratio of 4:1. The lowest age was 18 years and the highest age was 66 years. The major cause (80%) was post operative soft tissue defect and in 20 % case it was due to high voltage electric burn. In 8 cases there were exposed implants. The standard myocutaneous flap was harvested in all cases. The donor site was closed primarily in all cases. In 03 cases skin graft was placed over transferred muscle. The outcome of reconstruction was satisfactory in all cases. Four patients had minor complications (managed non operatively), one of the patients had surgical site infection which was controlled according to culture-specific antibiotics, and another two patients had partial dehiscence of donor site wound which healed spontaneously. One patient developed seroma in donor site which resolved in time with local care. Conclusion: Pedicled Latissimus dorsi muscle flap is a straight forward and versatile option for reconstruction of soft tissue defect with exposed spine with minimal donor site morbidity. J Rang Med Col.2026 Mar;11(1): 136-140
Outcome of Botulinum Toxin Therapy for Management of Chronic Anal Fissure: A Prospective Study of 60 Patients
Background: Chronic anal fissure (CAF) is a common anorectal disorder characterized by severe pain during defecation and impaired quality of life. While lateral internal sphincterotomy remains the standard treatment, it carries the risk of incontinence. Botulinum toxin (BTX) injection has emerged as a minimally invasive alternative. Objective: To evaluate the efficacy and safety of BTX therapy in the management of CAF in a cohort of 60 patients. Methods: This prospective study included 60 patients diagnosed with CAF at department of colorectal surgery, Bangladesh Medical University from January 2024 to December 2025. BTX-A was administered via injection into the internal anal sphincter. Patients were followed for 12 weeks, with outcomes assessed in terms of pain relief, fissure healing, and adverse events. Results: Complete fissure healing was observed in 46 (76.7%) patients, while 10 (16.7%) showed partial healing, and 4 (6.6%) showed no response. Significant reduction in pain scores was reported at 2,4, and 8weeks post-treatment. Minor adverse events included transient incontinence in 4 patients (6.6%) and mild perianal discomfort in 8 patients (13.3%). No serious complications occurred. Conclusion: BTX therapy is a safe, effective, and minimally invasive treatment for CAF, providing substantial pain relief and high healing rates with minimal complications. It represents a viable alternative for patients at high risk of postoperative incontinence. J Rang Med Col.2026 Mar;11(1): 141-145
Proximal Femoral Nail Versus Proximal Femoral Locking Compression Plate in the Treatment of Unstable Trochanteric Fracture in Adults
Background: Unstable trochanteric fractures are common in adults and require stable fixation to enable early mobilization and reduce morbidity. Proximal femoral nail and proximal femoral locking compression plate are frequently used implants, but direct comparative data from local clinical settings remain limited. Objective: This study compared operative, radiological, and functional outcomes between these two fixation methods. Methods: This cross-sectional analytical study was conducted in the Department of Orthopaedic Surgery, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet from January 2017 to December 2018. Twelve adults with unstable trochanteric fractures were enrolled and allocated equally to nail or plate fixation. After clinical assessment and informed consent, fixation was performed as per group allocation. Patients were followed for 24 weeks, assessing operative variables, mobilization milestones, radiological union, complications, and functional outcome using the Harris Hip Score. Statistical significance was set at p<0.05. Results: Operation time was slightly longer with the nail (137.5 min) than the plate (116.7 min). Incision length was significantly shorter with the nail (11.2 cm vs 17.5 cm). Hospital stay was similar in both groups (3 days). The nail allowed earlier mobilization, with partial weight bearing at 3.3 weeks versus 9 weeks, and full weight bearing at 11 weeks versus 20 weeks in the plate group. Radiological union was identical (20 weeks), with 66.7% in each group uniting by 18 weeks. Complication rates were comparable, including implant failure (1 per group) and varus deformity (2 per group). Limb length discrepancy occurred only in the nail group (33.3%). Functional recovery at 24 weeks was similar, with mean scores of 81.0 (nail) and 83.2 (plate). Conclusion: Both implants were effective, but PFN offered advantages in minimal surgical exposure and earlier mobilization, supporting its preference in most unstable fractures. J Rang Med Col.2026 Mar;11(1): 146-152
Thrombocytopenia as a Predictor of Mortality in Neonatal Pulmonary Haemorrhage: A Cohort Study from a Tertiary Hospital in Bangladesh
Background: Neonatal pulmonary haemorrhage carries a high fatality risk, and simple prognostic markers are crucial in low-resource environments. Objective: This study assessed whether thrombocytopenia predicts mortality among affected neonates in a tertiary hospital in Bangladesh. Methods: A prospective cohort of seventy neonates with pulmonary haemorrhage, admitted between July 2019 and June 2021, was evaluated. Platelet counts were recorded at admission and monitored every 12 hours; thrombocytopenia was defined as <150,000/μL. Mortality during hospitalization served as the primary outcome. Results: Overall mortality reached 88.6%. Non-survivors had markedly lower platelet levels than survivors, and this difference was statistically significant. Regression analysis confirmed that thrombocytopenia is an independent predictor of mortality. Survivors also exhibited an earlier onset of haemorrhage compared with non-survivors. Conclusion: Routine platelet assessment provides a practical, accessible prognostic measure and underscore the need for standardized transfusion and monitoring strategies to improve survival. J Rang Med Col.2026 Mar;11(1): 153-158
Longitudinal Impact of Sleep Duration on Liver Stiffness Velocity in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Five-Year Prospective Cohort Study
Background: The clinical shift from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD) emphasizes identifying modifiable drivers of fibrotic progression. While obesity and diabetes are established risk factors, the independent impact of sleep duration on the "velocity" of liver stiffness measurement (LSM)-the longitudinal rate of change-remains poorly characterized. Objective: This study aimed to quantify the 5-year relationship between sleep duration and liver stiffness velocity. Methods: We conducted a prospective cohort study of 1,076 participants in Bangladesh (Dhaka, Rangpur, Sylhet) from 2020 to 2025. Baseline and 5-year liver stiffness were measured using vibration-controlled transient elastography (VCTE). Sleep duration was assessed via the Pittsburgh Sleep Quality Index (PSQI). Multivariable regression and causal mediation analysis evaluated the impact of sleep on LSM change (Δ LSM). Results: Over 5 years, 19.7% of individuals were Progressors. Multivariable regression established sleep duration as a potent independent predictor of liver stiffness velocity (β=-0.20,95% CI: -0.28, -0.12, p<0.001), while BMI was not a significant longitudinal driver in adjusted models. Mediation analysis confirmed a significant direct effect of sleep on Δ LSM (ADE=-0.19, p<0.001), with negligible mediation by BMI. Survival analysis showed that individuals sleeping ≤6 hours had a significantly higher hazard for reaching advanced fibrosis compared to those sleeping ≥6 hours. Conclusion: Short sleep duration is a direct, primary driver of liver stiffness velocity in MASLD. Restorative sleep (≥7 hours) is associated with stability and is a prerequisite for fibrosis regression. Addressing sleep hygiene is a critical, independent therapeutic target for preventing advanced liver disease. J Rang Med Col.2026 Mar;11(1): 159-165
Assessment of Flap Viability and Complication in Free Flap Reconstruction of Lower Third Leg and Foot Defects
Background: Composite defects of the lower third leg and foot present significant reconstructive challenges due to limited local tissue availability, poor vascularity, and the frequent presence of exposed bone, tendon, or implants. Free flap reconstruction has become the preferred method for achieving durable coverage in this region yet flap viability and complication patterns may vary depending on patient factors, defect characteristics, flap type, and recipient vessels. Evidence from Bangladesh is limited despite the increasing burden of lower limb trauma and oncologic resections requiring microsurgical reconstruction. Objective: This study evaluated flap viability and early postoperative complications following free flap reconstruction of distal lower limb defects in a tertiary hospital setting. Methods: This prospective observational study was conducted in the Departments of Orthopedics and Burn & Plastic Surgery at Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh, from July 2015 to June 2017. Eleven patients with composite defects of the lower third leg or foot requiring free flap coverage were consecutively enrolled. Data on patient demographics, comorbidities, defect etiology and site, flap type, flap size, and recipient vessels were collected prospectively. All free flaps were performed using standard microsurgical techniques, with postoperative monitoring following institutional protocols. Flap outcomes were categorized according to the Srikant classification. Minor complications included wound infection and partial graft loss, while major complications required surgical intervention. Descriptive statistics were used for analysis. Results: All 11 free flaps demonstrated complete survival, resulting in a flap viability rate of 100%. According to the Srikant classification, 72.7% of flaps achieved Grade 1 outcomes, 18.2% achieved Grade 2 outcomes, and 9.1% were Grade 3, reflecting partial non-critical losses. No cases of Grade 4 or Grade 5 flap failure occurred. Minor complications were observed in 18.2% of cases, and one major complication (9.1%) required secondary surgical management. The anterolateral thigh (ALT) flap was most commonly used (72.7%), while the anterior tibial artery served as the primary recipient vessel (81.8%). Neither flap type nor vessel choice showed a clear association with flap loss due to the overall high survival rate. Conclusion: Free flap reconstruction demonstrated excellent viability and low complication rates in patients with composite defects of the lower third leg and foot. The consistent success across flap types and recipient vessels highlights the reliability of microsurgical reconstruction in this region. J Rang Med Col.2026 Mar;11(1): 166-171
Diagnostic Significance of Pleural Fluid ADA and Hematological Parameters in Pediatric Tubercular Versus Non-Tubercular Pleural Effusion
Background: Pediatric pleural effusions arise from diverse etiologies, with tuberculous pleural effusion (TPE) and non-tuberculous causes being the most common. Early differentiation is essential for timely management. Objective: This study aimed to evaluate the diagnostic significance of pleural fluid ADA and hematological parameters in distinguishing pediatric tubercular versus non-tubercular pleural effusions. Methods: A cross-sectional study was conducted at Bangladesh Shishu Hospital and Institute from July 2019 to January 2022, including 47 children aged 1-18 years with pleural effusion. The diagnostic performance of pleural fluid ADA and key hematological parameters was analyzed using SPSS 26. Results: Pleural ADA was markedly higher in TPE than in non-TPE cases (90.6±52.0 vs. 36.0±11.5 U/L). TPE patients showed significantly lower total WBC counts and polymorph percentages, but higher lymphocyte percentages and ESR (P<0.05). Hemoglobin, platelet count, and CRP showed no significant group differences. Conclusion: Pleural fluid ADA, combined with selected haematological parameters, provides meaningful discrimination between tubercular and non-tubercular pediatric pleural effusions and supports clinical decision-making. J Rang Med Col.2026 Mar;11(1):172-176
Relationship Between Thyroid Autoimmunity Status and Levothyroxine Dose in Hypothyroid Patients with or without Type 2 DM
Background: Hypothyroidism is the most common thyroid problem in Bangladesh and worldwide. Autoimmune thyroid disease is the most common cause of hypothyroidism. Levothyroxine (LT4) dose requirements vary among patients and may be influenced by thyroid autoantibody status and metabolic comorbidities such as type 2 diabetes mellitus (T2DM) to achieve euthyroidism. Objective: To assess the relationship between thyroid autoantibody status and levothyroxine dose requirements in hypothyroid patients with or without T2DM. Methods: This cross-sectional study was conducted at the Department of Biochemistry, BIRDEM General Hospital, from July 2024 to June 2025 on 100 patients with hypothyroidism recruited from outpatient department of endocrinology, BIRDEM, Dhaka, and divided into two groups: Group 1 (Hypothyroid patients with T2DM, n=50) and Group 2 (Hypothyroid patients without T2DM, n=50). Data on demographic, physical, biochemical variables and dose of levothyroxine were collected. Thyroid peroxidase (TPO) antibody, thyroglobulin (Tg) antibody, TSH and HbA1c were measured. Statistical analysis was performed using SPSS version 29.0. Results: Among 100 patients with hypothyroidism, mean age was 49.66±11.19 years in Group 1 and 45.84±14.4 years in Group 2. TPO antibody positivity was significantly lower in hypothyroid patients with T2DM (36%) compared to those without T2DM (66%) (p=0.003).The mean levothyroxine dose was substantially higher among anti-TPO positive patients than anti-TPO negative patients (67.6±28.0 μg vs. 40.6±17.8 μg, p<0.001), with a similar pattern observed for anti-Tg positivity (74.1±32.3 μg vs. 46.7±20.3 μg, p<0.001). Conclusion: Thyroid autoantibody positivity is strongly associated with higher levothyroxine dose requirements in hypothyroid patients, irrespective of diabetes status. Recognition of thyroid autoimmunity is essential for individualized dose optimization. J Rang Med Col.2026 Mar;11(1):177-182
Neurodevelopmental and Growth Outcomes Among Low-Birth-Weight Infants Receiving Early Kangaroo Mother Care: A Cross-Sectional Study
Background: Infants with low-birth-weight face heightened risks of mortality, growth retardation, and neurodevelopmental deficits, especially in resource-limited environments. Kangaroo Mother Care (KMC) enhances survival and growth. However, data concerning its long-term neurodevelopmental effects in Bangladesh is still insufficient. Objective: To evaluate neurodevelopmental and growth outcomes in low-birth-weight children receiving early Kangaroo Mother Care and to identify predictors of developmental delay. Methods: This cross-sectional analytical study was conducted at Bangladesh Shishu Hospital & amp; Institute, Dhaka from June 2023 to November 2023, involving 65 low-birth-weight children aged 12 to 36 months who received early Kangaroo Mother Care there. The ASQ-3 was used to look at neurodevelopment, and WHO standards were used to look at anthropometric measurements. Chi-square tests, independent t-tests, pearson correlation, and multivariable logistic regression were used to identify predictors of developmental delay. Results: In general, 67.9% of children demonstrated age-appropriate growth across all areas, with early initiation of Kangaroo Mother Care within 24 hours (AOR=0.38, p=0.026) and daily practice exceeding eight hours (AOR=0.41, p=0.045) serving as protective factors. A longer duration of KMC was positively associated with elevated ASQ-3 scores (r=0.18–0.29, p<0.05). Children with delays had much lower anthropometric measurements. Conclusion: Early and continuous Kangaroo Mother Care enhances neurodevelopment and growth in low-birth-weight children, underscoring its significance in conjunction with nurturing home environments in resource-constrained contexts. J Rang Med Col.2026 Mar;11(1): 183-188
Comparative Evaluation of Green Tea Pretreatment on Serum Biochemical Markers in Gentamicin-Induced Nephrotoxicity among Long Evans Rats
Background: Aminoglycoside antibiotic gentamicin is a widely used clinical agent with nephrotoxicity that is dose related. The pathogenesis of kidney injury that occurs due to drugs is based on oxidative stress. Objective: Methods: The experimental in vivo study was carried out from 1st July 2019 to 30th June 2020 in Sir Salimullah Medical College, Dhakawhere 30 healthy male Long Evans rats aged between 90-120 days. Statistical analysis was done using SPSS v22 with ANOVA and post hoc Bonferonni test (p _ 0.05). Results: Green tea pretreatment significantly reduced the gentamicin-induced increases in serum creatinine (1.02±0.12 vs 1.54±0.16 mg/dL, p<0.001), serum urea(46.2±4.9 vs 72.3±6.1mg/dL, p<0.001), and BUN (22.1±2.4 vs 33.7±3.1mg. The pretreatment group had an intermediate weight of the kidneys (1.14-0.20g) compared to the control group and the gentamicin-treated group. Conclusion: The green tea extract is effective in providing meaningful nephroprotective effects in gentamicin-induced kidney injury, which is probably due to antioxidant effect. J Rang Med Col.2026 Mar;11(1): 189-195
Intraoperative Findings and Difficulties Encountered During Laparoscopic Cholecystectomy: An Observational Study
Background: Laparoscopic cholecystectomy is the standard intervention for symptomatic gallstone disease; however, intraoperative challenges can prolong surgery or increase complications. Objective: This study evaluated the frequency and determinants of operative difficulties. Methods: A prospective observational study was conducted among 67 patients undergoing laparoscopic cholecystectomy at Green Life Medical College Hospital between January 2022 and December 2023. Patients with cirrhosis, malignancy, prior upper abdominal surgery, or coagulation disorders were excluded. Intraoperative variables, including gallbladder wall thickness, adhesions, anatomical variations, and dissection complexity, were documented. Results: Standard procedures were completed in 76.1% of cases, whereas 14.9% were classified as difficult. Distended or congested gallbladder (32.8%) and omental wrapping (20.9%) were common findings. Thick gallbladder wall _3 mm, dense adhesions, and difficult Calot’s triangle dissection independently predicted operative difficulty. Conclusion: Preoperative identification of gallbladder wall thickening, adhesions, and complex Calot’s triangle anatomy may help anticipate a challenging laparoscopic cholecystectomy. J Rang Med Col.2026 Mar;11(1): 196-201
Clinicopathological Presentation of Lupus Nephritis
Background: Despite great improvement in the management of lupus nephritis, it remains the most frequent cause of SLE-related mortality. It has diversities of clinical and histological presentations. Objective: The aim of this study was to observe the most common clinicopathological presentations of lupus nephritis (LN). Methods: This cross-sectional observational study was conducted among thirty patients with lupus nephritis, admitted into department of Medicine, Rangpur Medical College and Hospital during June, 2023 to May, 2024 through convenient sampling. After written consent, all patients were undergone renal biopsy and tissue was analyzed for histopathological examination. After compilation data was analyzed by SPSS version 25.0. Results: Out of thirty patients female were 27(90%) and male 3(10%), most of them 21(70.00%) were at childbearing age between 18 and 35 years, the mean age was 24.16±4.23 years. The most frequent clinical features were edema (100%), joint pain/arthralgia 18(60.00%), fever 16(53.33%) and oral ulceration 11(36.66%). On examination 21(70%) patients were anaemic, 18(60%) patients had microscopic hematuria and proteinuria >0.5 gm/24 hours was noticed in all patients. Among the respondents 18(60.00%) patients had nephrotic range of proteinuria. 10(33.33%) patients had serum creatinine >1.40 mg/dl. On serological test 28(93.3%) patients had a positive ANA, 27(90%) patients had a positive anti-ds DNA. The most common histological feature was class IV in 17(56.70%) patients, followed by 6(20.00%) patients had Class II, 4(13%) patients had Class V and 2(6.7%) patients had Class III lupus nephritis. Conclusion: Generalized swelling/ edema was the commonest clinical presentation with class IV lupus nephritis on histology . J Rang Med Col.2026 Mar;11(1): 202-207
Role of Fine Needle Aspiration Cytology (FNAC) in the Differential Diagnosis of Neck Swelling: A Hospital Based Study
Background: Both neck swellings are usually due to lymph nodes, thyroid, paralymphatic, or soft tissue swellings that can vary from inflammatory to malignancies, which are manifestations of head and neck malignancies in adults. FNAC, USG-guided FNAC, and ultrasonography are the major diagnostic modalities in hematologic swellings of lymph nodes that are accurate to the extent of 82–96% sensitivity and in nonthyroid swellings of the neck that are accurate for their sensitivity of 93% and specificity of 72%. This study aims to investigate the cytological distribution of FNAC in 61 cases. Objective: To assess the diagnostic efficacy, accuracy, and cytological findings of Fine Needle Aspiration Cytology (FNAC) in case of neck swellings and correlation of cytological results with demographic details and site-wise distribution for appropriate patient care. Methods: This retrospective study included 61 patients with head and neck swellings from the Department of ENT, Ad-Din Sakina Hospital, between December 2024 and March 2025; FNAC was performed in all cases under strict aseptic conditions using a 23-gauge needle and 10-ml syringe, with aspirated material stained by MGG, H&E, and Papanicolaou methods, Z-N staining applied for suspected tuberculous or purulent cases, and repeat FNAC conducted when initial samples were inadequate. Results: Among 61 FNAC-evaluated neck swellings, thyroid lesions were most common (42.6%), followed by neck and parotid swellings (13.1% each), with female predominance (~66%) and peak incidence in middle age (45–59 years; 26.2%); cytology showed mainly benign and inflammatory lesions predominantly nodular goiter and lymphadenitis (14.8% each) with fewer malignant cases, highlighting FNAC’s effectiveness in characterizing the anatomical and cytological spectrum. Conclusion: Neck swellings predominantly involve the thyroid gland with female and mid-life predominance, are largely benign with inflammatory and benign neoplastic lesions forming the majority despite a notable malignant proportion, and FNAC proves to be a precise, minimally invasive, and indispensable primary diagnostic tool enabling reliable benign–malignant differentiation and optimal clinical management. J Rang Med Col.2026 Mar;11(1): 208-212
Hepatic hemangiomas are the most common benign liver tumors, typically asymptomatic and discovered incidentally. Giant hepatic hemangiomas (>10 cm) are rare and may present with symptoms due to mass effect. This report describes a 45-year-old woman presenting with abdominal fullness due to a massive hepatic hemangioma measuring approximately 20.5×17.5×23 cm in the left lobe, with a smaller lesion in the right lobe. Diagnosis was confirmed via ultrasonography, contrast-enhanced computed tomography (CECT), and fine-needle aspiration cytology (FNAC). Laboratory findings included mild normocytic normochromic anemia and leucopenia, with normal liver function tests and tumor markers. Management was conservative, with recommendations for open biopsy. This case underscores the diagnostic utility of multiphasic imaging and the benign nature of these lesions, supported by a review of similar cases in the literature. J Rang Med Col.2026 Mar;11(1):221-225
Abstract not available J Rang Med Col.2026 Mar;11(1):1-2
Sexually Transmitted Infections in Bangladesh: A Narrative Synthesis of Multidimensional Impact
Background: Sexually transmitted infections (STIs) remain a global public health challenge, especially in low- and middle-income countries where social, economic, and structural factors increase vulnerability. Objective: The objective of this narrative review was to synthesize evidence on the epidemiology, determinants, multidimensional impacts, and prevention strategies of sexually transmitted infections (STIs) in Bangladesh. Methods: A narrative literature review of studies published from 2000 to 2024 was conducted using PubMed, ScienceDirect, and Google Scholar. Ten studies met inclusion criteria. Data were analyzed using qualitative content analysis, categorizing themes into epidemiology, determinants, impacts, and control strategies. Results: HIV appeared in 20% of studies, mostly among people who inject drugs, while 60% reported high prevalence of other STIs among female sex workers. Structural determinants such as poverty and inequality were identified in 30% of studies, and behavioural factors such as low condom use in 20%. Health complications (60%), social stigma (20%), and gender-related vulnerability (20%) were documented. Prevention strategies were discussed in 70% of studies, but were mostly population-specific rather than integrated. Conclusion: STIs in Bangladesh are influenced by behavioural, social, and structural determinants. Integrated, inclusive, and evidence-based interventions addressing both individual and societal risk factors are necessary to prevent future escalation. J Rang Med Col.2026 Mar;11(1): 213-220