Comilla Medical College

Background: Nephrological changes in Multiple Myeloma occur mostly because of abnormal proteins (light chains) production by myeloma cells which causes deterioration of kidney functions. The aim of the study was to determine the renal impairment in multiple myeloma patients. Method: A total of 159 newly diagnosed multiple myeloma aged 24 to 85 patients were selected in this retrospective cross-sectional study conducted from January 2017 to December 2020 according to the selection criteria. Result: The study sample consists of 103 (64.8%) male patients and 56 (35.2%) female patients. The median age of the patients was 63±13 years. Among them, 6.9% patients were less than 40 years old, and 32.7% patients were more than 70 years old. Renal impairment was found in 86 (54%) patients. The highest incidence of renal impairment was found in 55–69-year age group and p-value was not statistically significant. Monoclonal gammopathy was detected in 138 (93.9%) patients. The study also stated that IgG Kappa was found in 41.8% patients, Kappa Light Chain was 4.1% and Lambda Light Chain was found in 4.1% patients. Conclusion: Multiple myeloma with renal involvement is a medical emergency. It needs immediate management, and the treatment plan is different in some regards. So, detection of nephrological abnormalities and treated accordingly is very crucial.

Background: The spleen is the largest lymphatic organ and plays a vital role in blood filtration and immunity. Splenic length is a key diagnostic parameter in hematological and gastrointestinal disorders, and ultrasonography offers a reliable, noninvasive method of measurement. Aim: To find out the normal range of the splenic length and its correlation with age, sex, and height in healthy Bangladeshi adults. Materials and Methods: A cross-sectional study was conducted from July 2015 to June 2016 among 104 adults (52 males, 52 females) aged 18-60 years at the Department of Anatomy, Rajshahi Medical College, Bangladesh. Splenic length was measured ultrasonographic ally along the longest coronal axis during deep inspiration. Body height was recorded, and correlations were analyzed using SPSS. Results: The overall mean splenic length was 9.62 ± 0.94 cm, being significantly larger in males (10.00 ± 0.97 cm) than in females (9.25 ± 0.74 cm, p < 0.000). Splenic length had a positive correlation with height (r = 0.908, p < 0.01) and a negative correlation with age (r = -0.714, p < 0.01). Conclusion: The splenic lengths of Bangladeshi adults range from 8.03 to 11.98 cm, are higher in males, decrease with age, and increase with height. These reference values help clinicians and radiologists differentiate normal spleen size from pathological splenomegaly or atrophy during routine practice.

Background: Muscular dystrophies encompass a diverse range of conditions that share the common feature of gradually worsening muscle weakness. Among these, Duchenne Muscular Dystrophy (DMD) stands out as the most prevalent X-linked form affecting children, usually manifesting in the early years of life. This condition primarily weakens muscles near the body's core and causes distinctive calf muscle enlargement in boys. Children with DMD typically show delayed motor milestones and progressive deterioration and ultimately bedbound. The condition often leads to early death due to cardiac or respiratory complications. Current interventions, including corticosteroid therapy and respiratory support, have enhanced daily functioning, mobility duration, overall well-being, and survival rates. However, researchers continue pursuing novel treatments in hopes of finding a definitive cure for this serious disease. This report presents the clinical case of a boy aged 10 years and 11 months diagnosed with DMD, focusing on his distinctive clinical presentation and other significant findings. Central Medical College Journal Vol 9 No 1 January 2025 Page: 53-56

Background: Lateral epicondylitis (LE) commonly known as tennis elbow, is a degenerative condition affecting the myotendinous junction of the wrist extensors at the lateral epicondyle, predominantly causing pain and reduced function in the affected arm. It is commonly seen in individuals over 45 years old who engage in high-risk activities involving repetitive wrist extension. Conservative management is the mainstay of treatment, but dry needling (DN) is a newer technique with limited evidence in treating LE. Methods: This study involved patients diagnosed with lateral epicondylitis at a tertiary care hospital in Bangladesh. Participants were divided into two groups: one receiving dry needling combined with conservative management, and the other receiving conservative management alone. Pain and functional outcomes were measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Visual Analog Scale (VAS) at baseline, 1 month, and 3 months post-treatment. Results: A total of 60 patients with lateral epicondylitis were enrolled and randomized into two groups: Group A (n=30) received dry needling in addition to conservative management (oral acetaminophen, exercises, and elbow counterforce brace), while Group B (n=30) received conservative management only. After accounting for losses to follow-up, 28 patients in Group A and 27 in Group B completed the 3-month follow-up. Baseline demographic and clinical characteristics were comparable between the groups (p>0.05). At 1 and 3 months, Group A showed significantly greater improvements in PRTEE pain, functional, and total scores compared to Group B (p<0.001). VAS scores also demonstrated significantly greater pain reduction in Group A at both follow-ups (p<0.001). Group A maintained progressive improvement over time, whereas Group B exhibited initial improvement at 1 month followed by regression toward baseline at 3 months. These findings suggest that dry needling, when combined with standard conservative treatment, offers superior and sustained clinical benefits in managing lateral epicondylitis. Conclusion: Dry needling, when combined with conservative management, appears to be an effective treatment for lateral epicondylitis, offering sustained improvements in pain and function. This technique could be a valuable adjunct to traditional treatments, although further studies with larger sample sizes are needed to confirm these findings. Central Medical College Journal Vol 9 No 1 January 2025 Page: 23-30

Introduction: Laparoscopic cholecystectomy is bread-and-butter not only for hepatobiliary surgeons, but also for general surgeons. To secure cystic duct clips are used routinely. Suture ligation of cystic duct and its various methods have been also described. But there is insufficient studies comparing the various methods prospectively. Objectives: To compare feasibility, operative time (incision to closer), postoperative pain, operative cost, complications of procedure, and cosmetic outcome between patients treated by laparoscopic cholecystectomy with either extracorporeal knotting or clip ligation of cystic duct. Methodology: This was a randomized controlled trial conducted from July 2021 to June 2024. Study patients selected for laparoscopic cholecystectomy were assigned by randomization in to two groups: patients who were treated by extracorporeal knotting through 5 mm epigastric port (study group), and in control group where clips were used. Results: Five hundred and six cases were subjected to laparoscopic cholecystectomy during study period. In study group, operation was significantly prolonged (68.25 Vs. 59.37minutes). Ligation of cystic duct by using suture is cost effective than clips (300 vs. 500 BDT). Both groups had no significant complications. Clip less study group shows cosmetic superiority than clipped control group. Conclusion: Extracorporeal ligation of cystic duct is safe, economic and cosmetically better in comparison to clip ligation for laparoscopic cholecystectomy. The limitation is operative time.

Background: Renal cell carcinoma (RCC) represents the commonest form of kidney cancer, constituting approximately 90% of all diagnosed kidney cancer. Patients with over expression of BCL-2 in renal cell carcinoma have a poorer prognosis. BCL-2 expression in RCC may assist in the targeted therapies and improve patient management. Aim: To evaluate the expression of BCL-2 in histomorphologically diagnosed renal cell carcinoma and its association with histopathological stage (pT). Methods: This cross-sectional study was conducted in the Department of Pathology, Dhaka Medical College, Dhaka, from March 2021 to February 2023 among purposively included 60 histomorphologically diagnosed RCC patients. Immunostaining with BCL-2 antibody was also done and findings were recorded. Statistical analysis was carried out using the SPSS software version 25. Results: A total of 26 (43.3%) patients were in pT2 stage, 24 (40.0%) patients belonged to pT1 stage and the remaining 10 (16.7%) patients were in pT3 stage. Positive expression of BCL-2 was detected in 37 (61.7%) cases while 23 (38.3%) patients had negative BCL-2 expression. BCL-2 expression was significantly associated with pT stage (p=0.035). Conclusion: BCL-2 immunomarker, combined with histopathological staging can identify individuals at high risk for kidney cancer. BCL-2 expression is crucial for patients with cancer that does not respond to chemotherapy. J Dhaka Med Coll. 2024; 33(2) : 69-73

ABSTRACT The study was conducted to estimate the protective effectiveness (PE) of complete primary or booster dose regimens of COVID-19 vaccines deployed in Bangladesh. The study was conducted in four hospitals in Dhaka between December 30, 2021, and August 31, 2022 following a test-negative design. Patients aged ≥18 years attended with COVID-like symptoms were enrolled and tested for RT-PCR. Test-negative controls were matched to confirmed cases at a 1:1 ratio considering site, date, and age groups. Conditional logistic regression was used to estimate the PE considering the association between receipt of complete primary with or without a booster regimen and development of COVID-19 disease symptoms. Whole genome sequencing (WGS) was carried out to confirm the variants. RT-PCR positive 847 cases were matched to 847 controls. WGS of strains revealed 6% to be the Delta variant and 94% was Omicron variant. The PE conferred by receipt of complete primary regimen with or without booster dose of any vaccine revealed no significant protection (15%, 95% CI: −11 to 36, p = .23) against any COVID-19 disease or severe disease (14%, 95%CI: −23 to 39, p = .42). However, there was a protective association between receipt of complete primary regimen with or without booster dose of one mRNA vaccine (Pfizer-BioNTech) against any COVID-19 disease (88% (95% CI: 26 to 98, p = .023)) for the first 90 days. The analysis suggested little vaccine effectiveness during Omicron surge, with the possible exception of one mRNA-vaccine 90 days after dosing.

To the Editor: We commend the publication of the article “Surgical Adverse Events for Primary Tumors of the Spine and Their Impact on Outcomes” by Laflamme et al.1 This multicenter observational study offers valuable insights into the prevalence and implications of postoperative complications in spine tumor surgery. The authors report that 42.5% of patients experience adverse events (AEs) after surgery, yet patient-reported outcomes at 12 months remain largely unaffected.1 This finding is consistent with previous research indicating that while AEs can increase short-term morbidity, their long-term functional effect varies significantly.2,3 Importantly, the study highlights that major AEs (grades 3-6) correlate with higher readmission rates (12.2%), underscoring the clinical burden of these complications.1,4 However, the lack of stratification by tumor histology and surgical approach limits the ability to draw deeper conclusions regarding specific risk factors and AE patterns.5,6 A noteworthy aspect of this study is its evaluation of en bloc resections, which are associated with higher intraoperative AE rates (17.9%), particularly dural tears and vascular injuries.1,7 These findings align with prior reports indicating that spinal tumor surgeries using anterior approaches carry increased risks of hemorrhage and nerve injury.8,9 Although en bloc resection is often associated with improved oncological control, the study does not demonstrate a survival advantage, likely because of the heterogeneous nature of tumor types and limitations in the follow-up period.10,11 Furthermore, the reported postoperative AE rate of 35% in the AO Spine Knowledge Forum Tumor registry suggests potential underreporting of complications across institutions.12,13 The identification of longer operative time and older age as independent risk factors for AEs is consistent with existing literature that emphasizes the effect of surgical complexity on postoperative morbidity.14,15 Although this study provides a robust multicenter perspective, future research should prioritize prospective trials with standardized AE monitoring across institutions.16 In addition, investigating the role of minimally invasive techniques in reducing AEs, particularly for spinal chordomas and chondrosarcomas, would be beneficial.17,18 The absence of long-term survival analysis is another limitation, as previous studies have indicated that AEs may delay adjuvant radiotherapy, potentially affecting overall prognosis.19,20 Despite these limitations, this study significantly contributes to preoperative risk stratification and shared decision making in spinal oncology. We commend the authors for their important work and look forward to further advancements in this field.

e16475 Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily driven by KIT or PDGFRA mutations. Imatinib has transformed GIST treatment; however, resistance typically emerges within 20–24 months, necessitating effective second-line therapies such as sunitinib, regorafenib, ripretinib, and masitinib. Methods: A Bayesian network meta-analysis of 17 studies including 2,422 patients evaluated the efficacy of tyrosine kinase inhibitors (TKIs) and other targeted therapies for progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) in imatinib-resistant GIST. Mean differences (MDs) and relative risks (RRs) with 95% credible intervals (CrIs) were calculated, and treatments were ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values. Control was used as the reference in all comparisons. Results: For PFS, masitinib showed the most significant improvement (MD: 11.78 months, 95% CrI: 0.29–23.49; SUCRA: 86.52%), followed by regorafenib (MD: 9.33 months, 95% CrI: 4.15–14.88; SUCRA: 79.7%) and sunitinib (MD: 8.68 months, 95% CrI: 3.47–14.13; SUCRA: 74.71%). In OS, masitinib ranked highest (MD: 34.09 months, 95% CrI: -20.64 to 90.13; SUCRA: 83.56%), followed by regorafenib (MD: 27.35 months, 95% CrI: -35.13 to 90.22; SUCRA: 76.96%) and sunitinib (MD: 17.16 months, 95% CrI: -9.66 to 44.89; SUCRA: 69.96%). Regorafenib led in ORR (RR: 8.23, 95% CrI: 0.68–97.04; SUCRA: 76.36%), followed by ripretinib (RR: 5.53, 95% CrI: 0.42–104.01; SUCRA: 63.91%) and sunitinib (RR: 4.56, 95% CrI: 0.66–40.67; SUCRA: 58.12%). Conclusions: Masitinib and regorafenib demonstrate the most promising efficacy for improving survival and treatment response in imatinib-resistant GIST patients. These findings emphasize the importance of tailored therapeutic strategies for advanced GIST management. Outcome Treatment Mean Difference / Relative Risk (95% CrI) SUCRA (%) Progression-Free Survival (PFS) (Months) Control Reference 26.00 Masitinib 11.78 (0.29 to 23.49) 86.52 Regorafenib 9.33 (4.15 to 14.88) 79.70 Sunitinib 8.68 (3.47 to 14.13) 74.71 Ripretinib 7.72 (0.04 to 15.50) 68.65 Sorafenib 3.10 (-8.19 to 13.73) 44.13 Pimitespib 2.33 (-7.75 to 12.46) 40.13 Overall Survival (OS) (Months) Control Reference 38.51 Masitinib 34.09 (-20.64 to 90.13) 83.56 Regorafenib 27.35 (-35.13 to 90.22) 76.96 Sunitinib 17.16 (-9.66 to 44.89) 69.96 Ripretinib 6.65 (-35.54 to 49.47) 50.83 Objective Response Rate (Relative Risk) Control Reference 15.94 Regorafenib 8.23 (0.68 to 97.04) 76.36 Ripretinib 5.53 (0.42 to 104.01) 63.91 Sunitinib 4.56 (0.66 to 40.67) 58.12 Sorafenib 4.95 (0.07 to 311.89) 57.53