Background: Peribulbar and sub-Tenon’s blocks are commonly used for ophthalmic surgery, but their complication profiles and clinical performance may differ.

Objective: To compare complications, block adequacy, patient comfort, and intraoperative outcomes associated with peribulbar and sub-Tenon’s blocks in ophthalmic surgery.

Methods: This prospective observational study included 160 adults undergoing elective ophthalmic surgery at S. M. College and Hospital, Uttar Pradesh, during 2008–2009. Patients received either peribulbar block or sub-Tenon’s block, with 80 patients in each group. Block-related complications, pain during administration, adequacy of anesthesia, need for supplementary anesthesia, intraoperative stability, and satisfaction scores were recorded.

Results: Overall complication rates were similar between peribulbar and sub-Tenon’s groups: 38 patients (47.5%) versus 39 patients (48.8%), respectively (p=0.874). Most complications were minor. One retrobulbar hemorrhage occurred in the peribulbar group, with no major complication in the sub-Tenon’s group. Pain during block administration was higher with peribulbar block (VAS 2.71±1.05 vs 1.50±0.86; p<0.001). Complete ocular akinesia was more frequent with peribulbar block (76.2% vs 47.5%; p<0.001), while inadequate block and supplementary anesthesia were more frequent with sub-Tenon’s block (13.8% vs 3.8%, p=0.025; 15.0% vs 3.8%, p=0.015). Patient satisfaction was higher with sub-Tenon’s block (4.26±0.84 vs 3.99±0.85; p=0.034).

Conclusion: Both blocks were safe, with similar overall complication rates. Peribulbar block provided better akinesia, whereas sub-Tenon’s block offered greater comfort and satisfaction.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly affects children’s daily lives, sleep, and school performance. The severity of the disease may influence the degree of quality-of-life impairment. This study aimed to assess the clinical profile, disease severity, and its impact on quality of life in children with atopic dermatitis attending a tertiary care hospital. Methods: This cross-sectional study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2007 to February 2008. In this study, we included 130 children aged 0-17 years with a confirmed diagnosis of atopic dermatitis, as determined by clinical criteria. Results: The mean age of participants was 8.4 ± 3.6 years, with a slight male predominance (56.9%). Most patients had moderate disease (44.6%), followed by mild (35.4%) and severe (20.0%). Pruritus was reported in 95.4% of children, and sleep disturbance in 52.3%. The most frequently affected body sites were the upper/lower limbs (83.7%) and elbows/knees (73.1%). The mean CDLQI score was 10.5 ± 6.0, with itching, sleep disturbance, and playing being the most affected domains. Adverse outcomes increased with disease severity: school absence (p = 0.017), sleep disturbance ≥3 nights/week (p < 0.001), and unscheduled clinic visits (p = 0.009). Conclusion: Atopic dermatitis imposes a considerable burden on children, particularly about itching, sleep disruption, and school functioning. Disease severity was significantly associated with adverse outcomes, underscoring the need for early recognition and comprehensive management.

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disorder that significantly affects quality of life, particularly in patients with moderate-to-severe disease. Biologic therapies targeting specific immune pathways have emerged as effective treatment options, yet data from Bangladesh are limited. This study aimed to evaluate the efficacy and safety of biologic agents in patients with moderate-to-severe psoriasis in a tertiary care hospital. Methods: This prospective observational study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2007 to June 2008. A total of 120 patients with moderate-to-severe plaque psoriasis (PASI >10 or body surface area >10%) were enrolled. Patients received biologic therapies including etanercept, infliximab, adalimumab, or alefacept as per clinical indication. Treatment response was assessed at 12 and 24 weeks using PASI 50, PASI 75 and PASI 90 criteria, while safety was evaluated through monitoring of adverse events and laboratory parameters. Data were analyzed using SPSS version 12. Results: The mean age of patients was 38.6 ± 12.4 years, with a male predominance (61.7%). Etanercept was the most commonly used biologic (40.0%). At week 24, PASI 50, PASI 75 and PASI 90 were achieved by 86.7%, 73.3% and 38.3% of patients, respectively. Biologics were well tolerated; injection site reactions (11.7%) and upper respiratory infections (8.3%) were the most common adverse events, while serious complications were rare. Overall, 73.3% of patients achieved significant clinical improvement (PASI ≥75). Conclusion: Biologic therapies are effective and safe in patients with moderate-to-severe psoriasis, providing substantial clinical benefit with a low incidence of serious adverse events in a tertiary care setting in Bangladesh.

Background: Common inflammatory dermatoses such as psoriasis, eczema, lichen planus, pityriasis rosea and seborrheic dermatitis often present with overlapping clinical features, making diagnosis challenging. Dermoscopy has emerged as a valuable non-invasive tool for enhancing diagnostic accuracy and guiding management. Methods: This retrospective study was conducted in the Department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, over a one-year period from March 2007 to February 2008. A total of 200 patients (mean age 32.8 ± 11.4 years; range 12–65 years) with suspected inflammatory dermatoses and complete dermoscopic records were included. Patients with infectious, neoplastic, adnexal, or connective tissue disorders, incomplete data, or poor-quality dermoscopic images were excluded. Dermoscopic features were analyzed and diagnostic performance was evaluated against final clinical diagnoses. Results: Psoriasis was the most common diagnosis (30.0%), followed by eczema/dermatitis (25.0%), lichen planus (20.0%), pityriasis rosea (12.5%) and seborrheic dermatitis (12.5%). Characteristic dermoscopic features included regular dotted vessels (86.7%) and diffuse white scales (81.7%) in psoriasis, Wickham striae in lichen planus (90.0%), collarette scaling in pityriasis rosea (84.0%) and yellow greasy scales in seborrheic dermatitis (88.0%). Sensitivity ranged from 78.0% for eczema to 90.0% for lichen planus, while specificity was highest for seborrheic dermatitis (97.0%). Overall diagnostic accuracy ranged between 82.5–95.0%. Clinically, dermoscopy avoided unnecessary biopsies in 31.0% of cases, supported immediate treatment decisions in 37.0% and changed the initial diagnosis in 14.0%. Conclusion: Dermoscopy significantly improves diagnostic accuracy and clinical decision-making in common inflammatory dermatoses, reducing the need for invasive procedures while enhancing patient management.

Background: Superficial fungal infections (SFIs) are among the most common dermatological conditions in the world with considerable regional variation according to age, sex, socioeconomic status, and climate. Tropical countries such as Bangladesh enjoy a hot and humid environment that favours the development of fungi. Although the prevalence is high, organized hospital-based data regarding the epidemiology of SFIs in Bangladesh are lacking. Aim of the study: The aim of this study was to assess the prevalence and risk factors associated with superficial fungal skin infections. Methods & Materials: This hospital-based cross-sectional study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2007 to February 2008. Total 200 patients presenting with clinically suspected superficial fungal infections were enrolled in this study. Result: Out of 200 patients, most were 21–30 years (30.0%), with slightly male predominance (55.0%). Students (25.0%) and lower-income segments (50.0%) were most frequently represented. Overcrowding (42.5%), poor hygiene (35.0%), and socioeconomic status (30.0%) were the most common risk factors, along with diabetes (15.0%), sharing of fomites (20.0%), and occupational exposure (10.0%). The most common infections were tinea corporis (25.0%), cruris (20.0%), and pedis (15.0%). Tinea capitis was mostly seen in children, and onychomycosis in older individuals. Male predominance was seen in most of the infections. Conclusion: Superficial fungal infections remain a significant public health concern in Bangladesh. Description of prevalent risk factors and infection patterns provides valid evidence for preventive care, patient education, and improved hospital-based management.

In this narrative review, we summarize the literature on optimal practices for surgical care in ectopic pregnancy, which is a common and potentially life-threatening gynecologic emergency necessitating urgent care to avoid maternal mortality and morbidity. A systematic review was undertaken of the literature searching of PubMed, MEDLINE and Cochrane databases of peer-reviewed articles prior to June 2009. Search: We searched “ectopic pregnancy”, “laparoscopy”, “salpingostomy”, “salpingectomy” and “surgical management” to identify relevant studies (a total of 36 studies). The review emphasizes laparoscopy as the treatment of choice for hemodynamically stable patients because of shorter recovery time (1-2 days compared with 5-7 days with laparotomy), less blood loss (50-100 ml compared with 200-300 ml), and cost effectiveness. Standard treatment for a ruptured ectopic is salpingectomy, with salpingostomy preferred for fertility preservation with 60-70% subsequent pregnancy rates but a 5-10% risk of remaining trophoblastic tissue. Clinical guidelines underscore individualized management according to patient stability, patient's desire for fertility, and characteristics of the ectopic. Drawbacks are difficulties with differing surgeon skills and resources of laparoscopic facilities, in particular in low resource settings. Important areas of research include long-term fertility results and standardized training curricula. This review reinforces laparoscopy as the gold standard and calls out for increased training, equal access, and more research to improve surgical results and fertility preservation.

Background: Traditional mono-focal intraocular lenses (IOLs) have been commonly used in cataract surgery but have limited intermediate vision. These lenses are designed to achieve improved visual outcomes and optical quality without the drawbacks associated with multifocal lenses. The present study compares visual outcomes, optical quality, and patient satisfaction for Monofocal versus Monofocal-Plus IOLs. Methods: This comparative observational study was carried out at Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), August 2007 and July 2008, including 40 cataract surgery patients. Patients were divided in Monofocal IOL (n=20) & Monofocal-Plus IOL (n=20) groups. Preoperative 1-month and 3-month follow-up assessments of visual acuity (LogMAR), contrast sensitivity (logCS), higher-order aberrations (HOA), and patient satisfaction scores were performed. SPSS version 26 was used to analyze data, with a p<0.05 significance level. Results: Uncorrected visual acuity was significantly better 3 months post-op with mono-focal-plus IOL at 3 months (p=0.008), photopic contrast sensitivity (p=0.04), and spherical aberration (p=0.00). There was a trend toward improvement in best-corrected visual acuity (p=0.08). Monofocal-Plus IOL patients reported significantly lower glare (p=0.01) and halos (p=0.01) and better night vision quality scores (p=0.005). The requirement for more spectacles was less in the Monofocal-Plus group (15.0% vs. 35.5%), but not significant (p=0.14). Conclusion: Compared to Monofocal IOLs, Monofocal-Plus IOLs provide better visual performance, optical quality, and higher patient satisfaction. These findings support their adoption as an IOL of choice in cataract surgery.

Background: Ocular trauma remains a significant public health issue, contributing to considerable morbidity. This study aimed to analyze the demographic, etiological, and clinical characteristics of mechanical ocular injuries presenting at a tertiary care center. Materials and Methods: A prospective observational study was conducted on 100 patients with mechanical ocular injuries from October 2008 to September 2009. Patients aged 18 years and above, cooperative for examination, and irrespective of economic status were included. Detailed histories, clinical findings, and treatment outcomes were documented and analysed. Results: The majority of patients (37%) were aged 21-30 years, with males (59%) predominating. Road traffic accidents (33%), especially involving two-wheelers, were the leading cause of injuries. Right-eye involvement was most common (58%), and corneal abrasions (30%) were the most frequent injury type. Severe injuries such as globe rupture and orbital fractures were more prevalent in males. Despite the significant burden, gender differences in injury types were not statistically significant. Conclusion: Young males are at the highest risk of ocular injuries, particularly from road traffic accidents. Targeted preventive measures, including stricter road safety regulations and public awareness campaigns, are essential to reduce the burden of ocular trauma.

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a major global health concern, especially in densely populated, low-resourced regions. It remains the leading infectious cause of adult mortality in Southeast Asia, which bears 40% of the global TB burden. Bangladesh, facing challenges such as overcrowding, poverty and limited healthcare infrastructure, reports 300,000 TB cases annually. Strengthening referral systems in Dhaka's chest clinics is vital to improving access to proper treatment, early diagnosis and treatment adherence for better TB control outcomes. Aim of the study: The objective of the study was to assess the impact of incentives given to TB suspects on referral success and compare the impact of TB patient incentives combined with DOTS strengthening with that of general DOTS strengthening and provider referral training. Methods: This quasi-experimental prospective study used a non-equivalent group design and was conducted at Shyamoli and Chankharpul Chest Clinics in Dhaka City. TB suspects from these clinics were referred to diagnostic NTP-NGO clinics from January 1, 2006, to December 31, 2006. A total of 2500 TB suspects, 1250 from each clinic, were initially diagnosed. Of these, 1078 were referred to NGO clinics and analyzed in two groups: Case group (N=631) with incentives and Control group (N=447) without incentives. Data were collected using TB Suspect Registers and referral slips and analyzed with SPSS using Chi-Square tests for categorical data, with p<0.05 considered significant. Result: In this study, the majority of individuals are between 15 and 44 years old (78.39%), with 15.96% between 45 and 64 years and 1.39% aged 65 or older. Gender distribution is fairly balanced, with slightly more females (53.62%) than males (46.38%). Most individuals reside in urban areas (58.91%) and over half are in the lower economic category (56.49%). Higher referral success in the case group (77.65%) compared to the control group (59.51%), a statistically significant difference (p<0.001). The results indicate no significant difference in treatment adherence between groups, with similar proportions of sputum-positive cases (p>0.05). Conclusion: This study highlights the positive impact of transportation incentives on referral success for TB suspects in Dhaka, with 77.65% referral success in the case group versus 59.51% in the control group. While no significant difference in treatment adherence was observed, the findings emphasize the importance of addressing logistical barriers for effective TB control.

Chlamydia is thought to be prevalent in 5-10% of 20-24 years old. About 75% of women and 50% of men are asymptomatic. The National Chlamydia Screening Programme currently finds about 8% of young people tested to be positive 1 but this may represent selective testing of higher risk individual. National Chlamydia Screening Programme (NCSP) This was initiated in 2003.The aims & objectives were early detection and treatment of asymptomatic infection, to reduce the onward transmission and to prevent the development of sequelae by screening all sexually active under the age of 25 years annually or with each change of sexual partner. The positive rate for this group in 2008 was 8.7% 1. An ideal setting to provide screening is General Practice. The nationally agreed target is for 25% of 15-25 years olds-males and females to be screened by 2009/2010 and 35% by 2010/2011.

The word 'psychiatry' is derived from the Greek for "doctor of the soul" and was first coined in the early 19th century by the German physician and anatomist, Johann Reil (1759-1813), although the treatment of mental disturbances dates back hundreds of years prior to this. The specialty of Psychiatry is regarded as dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of ‘mind’ illnesses or mental disorders. Diseases of the brain itself, for example encephalitis, tumours, and so forth, fall within the realm of neurology, generally. There are, of course, many overlapping disorders which cause neurological symptoms (paresis, slurred speech, ataxia, to cite a few) and ‘mind’ symptoms (depression, anxiety, psychosis). Disorders which affect several organ systems, for example, the autoimmune diseases, often cause multiple, bewildering neurological and mental symptoms. The primary goal of the psychiatrist is relief of suffering associated with ‘psychiatric’ disorders which include inappropriate anxiety, clinical depression, and psychotic disorders. Attempts have also been made to categorize and ‘treat’ different types of personality disorder. The latter is a contentious issue (perhaps with the exception of antisocial and borderline types) sometimes based on value judgments rather than clear scientific evidence. Treatment for mental health problems nowadays is usually community-orientated for less severe conditions and often hospital-based for more intractable disorders. The vast majority of patients are treated on a voluntary basis, whether in hospital or the community.

This is a case report of a pregnant woman with previous two cesarean sections whose uterus herniated in an incisional hernia of the anterior abdominal wall at 34 weeks of pregnancy. Incarceration of the pregnant uterus in an incisional hernia is a rare but serious obstetric situation. Treatment is conservative until term followed by delivery and herniorrhaphy, as was done in our case. This resulted in a successful outcome.

A 13-year-old female presented with a two-month history of right-sided back pain and five days of intermittent fever. The pain was worse on inspiration and made sleeping difficult. She denied wheezing, chest pain, or cough. She continued daily participation in competitive sports. Previous trials of antibiotics and an inhaled bronchodilator for presumed exercise-induced asthma were unsuccessful. Chest x-ray (CXR) showed a large cyst (10x10x8 cm3) in the posterior right lung. (Image 1). Computerized tomography (CT) scan showed a large cystic lesion arising entirely within the right lower lobe and extending the width of the hemithorax. (Image 2) There was an air-fluid level occupying~50% of the cavity. She was diagnosed with a multilocular bronchogenic cyst. She was briefly hospitalized and discharged on azithromycin with plans to respect the cyst in one month.

Among the hemorrhagic complications of warfarin therapy presenting with neurological symptoms, spinal epidural haematoma and retroperitoneal bleeding into the psoas and iliac muscles are two of the important diagnoses to consider. Spinal epidural haematoma (traumatic or spontaneous) is an uncommon, but recognized, clinical entity that needs emergency management. The association of spinal epidural hematomas with warfarin therapy has been described and, in 1956, Alderman1 stated that this diagnosis should be entertained in any patient receiving anticoagulants presenting with lower back pain or sciatic pain. Retroperitoneal bleeds on the other hand can be particularly difficult to diagnose and manage. Both are serious conditions, especially if there is a delay in diagnosis, as early treatment confers a marked prognostic advantage. Hence awareness, a high index of suspicion and a willingness to seek the prompt help of the imaging department, are crucial to successful management before the opportunity to treat is lost. A case report follows, the purpose of which is to increase the awareness among medical personnel and to stress the urgency of management

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year-old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was hemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero.

Objective: To test the hypothesis that an individual’s falls risk is a continuum and that physiological variation in the routine nursing observations in the lead up to the fall can be used to predict its occurrence when compared to the general hospital population. Methods: This study was a retrospective case-control study.13 Fallers were randomly selected and compared to 47 Controls matched for age, sex and equivalent length of stay. Routine nursing observations such as heart rate, systolic blood pressure, respiratory rate, temperature and patient at risk (PAR) scores were recorded and compared over the 12 hours preceding the fall. Data was compared using a Student Unpaired T-Test with Power calculated as > 80%. Variability   was     quantified by the range and standard deviation of the values      for      each      parameter. Results: The average (±SD) age of fallers in years (79 ± 16) was higher than of general medical admissions (67 ± 20) p<0.003. There was a predisposition to men falling (63%, p<0.001) compared to women. 70% were taking over 4 medications and most of the injuries were minor. The overall PAR score, temperature and respiratory rates were not predictive of falls and neither was their variability. There were no significant differences between the recorded heart rates or blood pressures between fallers and controls; however, there was much greater variation in both. The range of heart rate variation was 15 ± 10 bpm in fallers, and 7 ± 7 bpm in controls p<0.001. The range of systolic blood pressure variation was 26 ± 12 mmHg in fallers and 11 ± 7 mmHg in controls p<0.001. Orthostatic hypotension was recorded in 2 patients prior to their falls. Conclusions: Cardiovascular variation as measured by increasing range is an acute predictor of falls risk despite relatively normal absolute values. This implies that falls risk should be regarded as a continuum, above and beyond recognized basal risk factors. We therefore recommend that falls risk should become an integral part of patients’ daily assessments and incorporate the patients’ physiology together with pre-existent pathology

Objective: Determine the impact and healthcare-seeking behaviour of women with dysmenorrhea. Design: Cross-sectional survey. Setting: Medical college,       nursing college,               hospital (staff      and        patient attendants), schools          and        suburbs of               Islamabad. Population: 1236 women aged 16–50. Exclusion criteria: pregnancy; gynecological or medical condition. Methods: Structured-questionnaire interviews. Main outcome measures: Impact, healthcare-seeking behaviour, and response to treatment. Results: Prevalence of premenstrual symptoms was: low back pain 879 (72%), depressed mood 484 (40%), headache 268 (22%), premenstrual fluid retention (body swelling) 218 (18%), and nausea 218 (18%). Predictors of pain score (linear regression coefficients) were: low back pain (0.39), headache (0.25), depressed mood (0.17) and nausea (0.17). Premenstrual symptoms affected household chores in 441 women (37%), household income 129 (11%) and social obligations 395 (33%). Students and self-employed women, 282 (63%) and 38 (63%) respectively, reported one or more days missed from school/work. Treatments sought were: conventional medicine by 496 women (56%); household remedies, 285 (32%); herbal 90 (10%); and homeopathic 125 (14%). Self-reported effectiveness of treatments was: conventional medicine (OR 13, 95% CI 8.7–21); household remedies (OR 6.5, 95% CI 4.1–11); herbal   (OR   4.1,   95%   CI   2.2–7.7).   Homeopathic   treatment   was    not    felt    to    be    effective    (OR    1.5,    95%    CI    0.89–2.6). Conclusions: Low back pain and headache contributed the most to severity of dysmenorrhea. Headache and body swelling (fluid retention) were predictive of days unable to work. Conventional medicine was used by more educated women and was perceived to be effective more often than other modalities.