Chittagong Medical College

Background: Production of cement is a dusty industrial process which includes emission of particulates, gases, solid waste, etc. Cement industries are regarded as one of the major source of environmental pollution. Cement factory workers are prone to occupational hazards. They encounter detrimental impact on their health due to prolong and repeated exposure to cement dust. This study was aimed at evaluating the effect of cement dust exposure duration on liver function parameters (Serum bilirubin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase) in cement factory workers. Materials and methods: Across-sectional comparative study design was adopted in this work. It was conducted in Department of Physiology, Chittagong Medical College in collaboration with Confidence cement factory Ltd. Chattogram from July 2022 to June 2023. Apparently healthy total 96 male subjects, aged between 20-50 years with BMI 18.5-27.5kg/m2 were included in this study by simple random sampling using lottery technique. Among them 48 cement factory workers, who were directly exposed to cement dust for at least 5 years and 48 subjects, engaged in desk job/office work, not directly exposed to cement dust in their working environment were enrolled in this study. To assess liver function serum ALT, AST, ALP and serum bilirubin were estimated. Unpaired Student’s t-test and ANOVA test were done for statistical analysis. Results: Mean values of serum ALT and AST were significantly higher in workers exposed for 10-14 years. Other parameters showed non significant changes between groups. Conclusion: The results of this study suggests that duration of exposure to cement dust might not cause significant differences in the liver function of cement factory workers. Chatt Maa Shi Hosp Med Coll J; Vol.24 (2); July 2025; Page 47-51

Cardiovascular diseases remain one of the leading causes of mortality worldwide, particularly in low- and middle-income countries. Early and accurate prediction of heart disease is essential for timely intervention and improved patient outcomes. Machine learning techniques offer promising solutions; however, challenges such as class imbalance, lack of interpretability, and limited real-world validation persist. In this study, a machine learning–based heart disease prediction framework was developed using a real-world clinical dataset comprising 5000 patient records collected from healthcare facilities in Bangladesh. Data preprocessing included cleaning, feature encoding, train–test splitting, and class imbalance handling using the Synthetic Minority Oversampling Technique (SMOTE). Multiple machine learning models—Logistic Regression, Decision Tree, Support Vector Machine, and Random Forest—were evaluated using 10-fold stratified cross-validation. Model performance was assessed using accuracy, precision, recall, and F1-score. SHAP (SHapley Additive exPlanations) was employed to enhance model interpretability. The best-performing model was deployed as a web-based decision support system. Among the evaluated models, the Random Forest classifier achieved the best performance, with an accuracy of 98%, recall of 96%, and F1-score of 96%. Ablation studies demonstrated the effectiveness of SMOTE, feature integration, and ensemble modeling. SHAP analysis identified clinically relevant features contributing to heart disease prediction, enhancing transparency and trust in model decisions. The proposed framework provides an accurate, interpretable, and practical solution for heart disease prediction using real-world clinical data. The integration of explainable machine learning and web-based deployment highlights its potential for clinical decision support. Future work will focus on multi-center prospective validation and adaptive model updating to further improve generalizability and real-world applicability. • A large real-world clinical dataset of 5000 patients was used for robust heart disease prediction. • A Random Forest model with SMOTE achieved high performance (98% accuracy, 96% recall). • Comprehensive ablation and model comparison analyses validate methodological robustness. • SHAP-based explainability provides transparent and clinically interpretable predictions. • The proposed system is deployed as a web-based clinical decision support tool.

Bangladesh has dramatically reduced its malaria burden since 2000, confining the disease to specific geographic zones. However, the national 2030 elimination goal is now threatened by a complex interplay of biological, ecological, and social factors. This narrative review synthesizes the country's malaria landscape from 2000 to 2025, analyzes the headwinds to elimination, and proposes a strategic framework that integrates genomic surveillance to address the nuanced challenges of residual transmission for the "last-mile" effort. A narrative review of scientific literature (January 2000-June 2025) was conducted using PubMed and Medline. The search strategy utilized relevant Medical Subject Headings (MeSH) to identify English-language, peer-reviewed articles on Bangladeshi malaria epidemiology, diagnostics, treatment, vector biology, and health systems, focusing on health outcomes and prevention strategies. The review confirms a > 90% reduction in malaria cases (2008-2020) driven by targeted vector control, RDTs, and ACTs, concentrating the remaining burden in the Chittagong Hill Tracts (CHT). While Plasmodium falciparum remains the dominant species responsible for the majority of the clinical burden, emerging challenges include: (1) biological threats like non-kelch13 artemisinin-partial resistance in Plasmodium falciparum and complexities of Plasmodium vivax radical cure amid G6PD deficiency; (2) ecological factors such as outdoor-biting vectors that evade bed nets; and (3) social dynamics, including high cross-border mobility and a large asymptomatic infection reservoir. The 2030 elimination target is attainable but requires a strategic pivot from broad control to a granular, intelligence-driven approach. Success depends on implementing solutions for outdoor-biting vectors, mainstreaming routine G6PD screening for safe P. vivax cure, and deploying robust genomic epidemiological surveillance to detect parasite resistance and human mobility. Addressing the specific needs of forest-going and ethnic minority communities bearing the remaining risk is essential for stopping the final transmission.

Introduction with Objective: The aim of the present study was to assess the Histopathological Evaluation of Post-Operative Biopsies in Oral Squamous Cell Carcinoma. Materials and Methods: This cross-sectional study was conducted from January 2020 to December 2021 in the oral and maxillofacial surgery department, DDCH. A total 85 cases were selected as study population as per inclusion and exclusion criteria. After data collection and processing, all statistical analysis were done by SPSS software windows version 29. Result: A large proportion of patients were diagnosed at an advanced stage, with 62.35% in Stage IV. Perineural invasion was present in 30.5% of cases, and lymphovascular invasion was seen in 31.8%. Histologically, the majority of cases were Grade I (76.4%), and Anneroth's Grade II (40%) was the most common. Adjacent bone involvement was found in 37.6% of cases, while 20% of patients exhibited tumor necrosis. Salivary gland involvement was noted in 17.6% of cases. Pathological TNM staging revealed the highest number of patients in the PT4aN0Mx group (19.10%) and the N0 group (48.23%). The study also examined the depth of invasion, with most cases falling between 1-9 mm (18.82%) and 10-19 mm (18.82%). Extranodal extension was present in 12 cases, and several statistically significant associations were found between histopathological features, such as the highly significant relationship between perineural invasion and bony involvement. Conclusion: In conclusion, this study identifies key socio-demographic and clinical traits of oral cancer patients, revealing frequent perineural, lymphovascular, and bone involvement that indicate the disease’s aggressive nature. Medicine Today 2026, Vol.38 (1): 60-64

Introduction with Objective: Tibial shaft fractures are the most prevalent type of tibia fracture. Intramedullary nailing is the standard procedure for surgical treatment of displaced tibial shaft fractures. Tibial nail insertion with suprapatellar approach with the knee in semi extended position which has advantage over infrapatellar approach. The aim of this study is to compare the surgical and clinical outcome of suprapatellar and infrapatellar approach for the tibial intramedullary nailing in patient with tibial shaft fractures. Methods: This Prospective Study was carried out among 48 patients attending at the department of Orthopedics Surgery at Chittagong Medical College Hospital; Chittagong for the treatment tibial fracture within the defined period from May 2022 to April 2023. Total 4 patients were dropped out in the middle of follow up. So follow up was done among 44 patients. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. Results: Twenty two patients in each group completed the study per protocol and included in the analysis. Both groups are comparable in terms of their age, fracture type and fracture location (P>0.05) .The average time of union was 3.52±0.898 months and 3.36±0.790 months respectively in suprapatellar and infrapatellar approach group (P=0.535). The average duration of operation was 90.04±8.035 and 76.46±9.060 minutes respectively in suprapatellar and infrapatellar approach group (P<0.001). Mean ± SD fsluroscopy time in suprapatellar approach was 115.58 ± 8.387 seconds and in infrapatellar approach was 105.38±9.102 (P<0.001). There was no significant difference among the two groups of nailing according P Value regarding complication like malalignment. Average ROM in suprapatellar approach group was 130.91±1.5 and in infrapatellar approach group was 125.38±1.88 (P<0.001). Suprapatellar approach shows significantly better outcome by mean Lysholm Knee score in comparison to infrapatellar approach according (P Value). The proportion of patients achieved excellent functional outcome was 18(81.8%) and 17(77.3%) in suprapatellar and infrapatellar approach group (P=0.892). Conclusion: It can be concluded that suprapatellar approach produced better functional outcome than infrapatellar approach in the treatment of tibial shaft fracture when considering mean lysholm knee score, range of motion and rate of malalignment in this present clinical trial. Medicine Today 2026, Vol.38 (1): 56-59

Background: Kartagener’s syndrome is a rare autosomal recessive disorder characterized by the triad of bronchiectasis, chronic sinusitis, and situs inversus due to defective motile cilia. Occasionally, ectodermal anomalies such as hair, nail, and dental abnormalities coexist, reflecting involvement of ectodermal structures. the present report is written for the purpose of reminding readers of this rare and severe situation and to emphasize the necessity for further research on how to deal with in best. Case Presentation: A 17-year-old female presented with recurrent productive cough since childhood, progressive hearing loss, delayed eruption of permanent teeth, patchy alopecia, and dystrophic nails. Imaging revealed dextrocardia and bilateral bronchiectasis. Sweating and secondary sexual characteristics were normal. The constellation of findings suggested Kartagener’s syndrome with associated ectodermal anomalies. Conclusion : This represents a rare overlap of Kartagener syndrome with ectodermal anomalies (Alopecia, dental agenesis, micronychia). Genetic testing is warranted to determine whether this represents a dual diagnosis or a novel syndromic variant. JCMCTA 2025 ; 36 (2) : 173-177

Background: Hemorrhagic Stroke (HS) is a devastating subtype of stroke with high mortality. The Intracerebral Hemorrhage Score (ICH Score) is a globally accepted prognostic tool for predicting 30-day mortality. To determine correlation between ICH Score and 30-day mortality in patients with HS at Neurosurgery Department of a tertiary hospital in Bangladesh. Materials and methods: A prospective observational study was conducted over 18 months, enrolling 288 adults with HS. The ICH Score was calculated at the time of admission. Patients were followed-up at 30-day by Glasgow Outcome Scale (GOS). Spearman’s correlation analysis was performed to determine correlation between ICH score and 30-day mortality. Results: The patients mean age was 59.6 years and 27 (9.5%) underwent surgical intervention. 30-day mortality rate was 42.25%. Strong positive correlation of ICH score was found with 30-day mortality (rho=0.984) and negative correlation was found with GOS score at 30-day (rho= 0.583). Mortality escalated with higher scores: 2.9% (Score 0), 27.1% (Score 1), 33.7% (Score 2), 72.9% (Score 3), 89.5% (Score 4) and 100% (Scores 5). Conclusions: The ICH score had positive correlation with 30-day mortality and acceptable in predicting 30-day mortality in HS. JCMCTA 2025 ; 36 (2) : 19-24

Background: Hepatitis B Virus (HBV) remains a major global health concern, particularly in regions with limited screening. Antibodies to the Hepatitis B core antigen (antiHBc) indicate past or ongoing infection and help identify potential carriers. This study aims to assess the seroprevalence of anti-HBc among HBsAg-negative blood donors in Chattogram. Materials and methods: This cross-sectional observational study included 100 voluntary blood donors who were screened for anti-HBc (IgM and IgG) and anti- HBs using Electrochemiluminescence Immunoassay (ECLIA) and Chemiluminescent Microparticle Immunoassay (CMIA) respectively. Results: The results revealed that 21% of the HBsAgnegative donors were positive for anti-HBc, indicating previous or ongoing hepatitis B virus (HBV) infection. Notably, 76.2% of the anti-HBc-positive individuals were negative for anti-HBs, suggesting a potential risk of HBV reactivation or occult infection. Homemakers had the highest anti-HBc positivity rate (25%) while students had the lowest (15.8%). Blood transfusion recipients (33.3%) and those with a history of surgery (30.8%) showed higher anti-HBc positivity rates compared to other risk factors. Unvaccinated individuals exhibited a higher anti-HBc positivity rate (26.3%) than vaccinated individuals (14.0.Prior blood donors accounted for 76.2% of all antiHBc-positive cases. Conclusion: These findings highlight the hidden burden of past HBV exposure among asymptomatic blood donors and emphasize the need for enhanced vaccination coverage, safe transfusion practices and the potential inclusion of anti-HBc testing in blood donor screening protocols to reduce the risk of occult HBV infections in endemic areas. JCMCTA 2025 ; 36 (2) : 7-12

Background: Type 2 Diabetes Mellitus (T2DM) is a significant public health concern, contributing substantially to morbidity, mortality and healthcare costs. Effective management of diabetes requires a comprehensive understanding of associated comorbidities, including their type and frequency, as these conditions influence treatment outcomes and self-management practices. This study aimed to assess the pattern of comorbidities among indigenous patients with T2DM attending a secondary-level hospital in Bangladesh and to evaluate their impact on glycemic control. Materials and methods: An analytic cross-sectional study was conducted among 132 adult T2DM patients attending Rangamati General Hospital between March and August 2023. Sociodemographic and clinical data were collected using a pretested structured case record form. Comorbidities were categorized as either previously diagnosed or newly detected through routine screening during the study. Glycemic status was classified based on HbA1c levels as follows: good control (<7%), inadequate control (7–8%) and poor control (>8%). Results: Only 22 patients (16.7%) achieved good glycemic control, 33 (25%) had inadequate control and 77 (56.3%) had poor glycemic control. Comorbid conditions were identified in 88 patients (66.7%). The most prevalent comorbidity was hypertension (54.5%), followed by dyslipidemia (50.8%) ischemic heart disease (18.9%) liver disease (8.3%) stroke (7.6%) and respiratory disease (6.1%). A total of 45 patients (34.1%) had one comorbid condition, 35 (26.5%) had two and 8 (6.1%) had three or more comorbidities. Multivariatelogistic regression revealed that the likelihood of having comorbidities was significantly associated with age >60 years (OR: 3.12, 95% CI: 1.82–9.15) male gender (OR: 1.19, 95% CI: 1.03–4.25) current smoking (OR: 1.98, 95% CI: 1.01–5.25) duration of diabetes >10 years (OR: 2.11, 95% CI: 1.12–6.45) and poor glycemic control (OR: 3.01, 95% CI: 1.03–10.14). Conclusion: The study highlights a high burden of comorbidities among indigenous patients with T2DM, with a significant impact on glycemic control. These findings underscore the need for targeted intervention strategies that address both diabetes and its associated comorbidities to improve health outcomes in indigenous populations. JCMCTA 2025 ; 36 (2) : 77-84

Background: Congenital Cyanotic Heart diseases refer to a bundle of different heart defects that present at birth. The result is low blood oxygen level. Cyanosis refers to bluish coloration of skin and mucus membrane. The purpose of the study to disseminate our knowledge and experience of clinical characteristics, presentation and treatment of the issue for readers as future reference. Case Presentation: In this case presentation, the anesthetic management of a 2year old baby on 28th September 2024, in Chittagong Medical College Hospital, who was diagnosed with an untreated Tetralogy of Fallot (TOF) complication a brain abscess, is described. Given the intricate relationship between the child's cardiac and neurological conditions, the patient's presentation of a brain abscess necessitated cautious evaluation of anesthesia. Conclusion: Specialized anesthetic techniques are vital for maintain hemodynamic stability, preventing additional hypoxemia and achieving successful operation. JCMCTA 2025 ; 36 (2) : 168-172