Eastern Medical College and Hospital

BackgroundChronic plaque psoriasis is a common immune-mediated dermatosis that often requires long-term systemic therapy in patients with moderate to severe disease. Methotrexate has been a cornerstone of systemic treatment for decades; however, concerns regarding delayed onset of action, cumulative toxicity, and the need for close laboratory monitoring have driven interest in newer targeted oral therapies. Tofacitinib, an oral Janus kinase (JAK) inhibitor, modulates multiple cytokine signaling pathways implicated in psoriasis pathogenesis, though comparative data from the Indian population remain limited.ObjectivesThe present study aimed to compare the efficacy, time to response, relapse rates, and safety profile of oral tofacitinib versus oral methotrexate in patients with moderate to severe chronic plaque psoriasis.MethodsThis prospective, randomized, open-label comparative study was conducted over 18 months (August 2023 to January 2025) at Great Eastern Medical School & Hospital, a tertiary care teaching hospital in South India. Adult patients with biopsy-proven chronic plaque psoriasis of at least three months’ duration, a Psoriasis Area and Severity Index (PASI) score greater than 10, and body surface area involvement exceeding 10% were enrolled. Forty-two eligible patients were randomized into two groups: Group A (n = 21) received oral tofacitinib 5 mg twice daily, while Group B (n = 21) received oral methotrexate 10 mg once weekly with folic acid supplementation. Clinical assessment using PASI was performed at baseline and at two, four, eight, 12, and 16 weeks. Treatment efficacy, PASI 75 and PASI 90 responses, time to PASI 75, relapse, and adverse events were analyzed.ResultsBoth treatment groups demonstrated a progressive and statistically significant reduction in mean PASI scores over the 16-week treatment period, with no statistically significant difference in mean PASI reduction between the two groups at individual follow-up visits. Tofacitinib showed a faster onset of action, with a higher proportion of patients achieving PASI 75 by week 12 (57.1%), whereas methotrexate demonstrated a higher cumulative PASI 75 response by week 16 (71.4%). Achievement of PASI 90 at week 16 was significantly higher in the tofacitinib group compared to the methotrexate group (57.1% vs. 19.0%; p < 0.05). Relapse was observed more frequently in the methotrexate group, although this difference did not reach statistical significance. Mild elevation of liver enzymes was the most commonly observed adverse effect in both groups, and no serious adverse events were recorded.ConclusionOral tofacitinib and methotrexate are both effective systemic therapies for moderate to severe chronic plaque psoriasis. Tofacitinib offers the advantage of faster and deeper clinical clearance, while methotrexate demonstrates comparable efficacy over a longer treatment duration. Tofacitinib may be considered a useful oral alternative in patients requiring rapid disease control.

BACKGROUNDAnterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autografts remains the gold standard for young, active individuals due to its superior biomechanical strength and bone-to-bone healing. However, donor site morbidity, particularly anterior knee pain (AKP), limits its utilization despite its advantages. Various techniques have been proposed to reduce AKP, but they show variable outcomes and several limitations.AIMTo assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.METHODSWe conducted a retrospective observational study of 24 patients aged 20-45 years, who had primary ACL reconstruction with BPTB grafts. During surgery, autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation. All patients were followed up for at least twelve months. Using the Kujala Anterior Knee Pain Score, clinical outcomes were evaluated, including the pain-specific subcomponent.RESULTSWith scores ranging from 86 to 100, the average overall Kujala score was 95.67 ± 4.01. No patient scored below 85. There was no complication such as patellar fracture, tibial tuberosity fracture, or infection. Grouped data showed 20.8% of patients scored 100, whereas 54.2% scored between 95 and 99, and 25% scored between 86 and 94. One patient (4.2%) had an 8/10 pain subcomponent, whereas 23 patients (95.8%) had a 10/10.CONCLUSIONThis procedure is easy to incorporate into routine surgical practice, cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses. Excellent short-term results back up this technique.

Factitious disorder with physical symptoms is a psychiatric disorder in which an individual deceives others by appearing sick, purposely getting sick or self-injuring. This was a case report of a 22-year-old married woman who was referred to us with a history of headache, nasal bleeding and unconsciousness as a primary clinical manifestation of a factitious disorder, which was diagnosed and treated after further investigation and psychiatric consultation. In this case report, the purpose was to raise the issue of psychiatric problems and their importance alongside physical problems, especially epistaxis. Jalalabad Med J 2025; 22 (1): 40-42.

Background: Acute Coronary Syndrome (ACS) is a significant manifestation of coronary artery disease (CAD). Severity of CAD is determined by SYNTAX score based on coronary angiogram which is an invasive procedure. A noninvasive evaluation of CAD severity by Triglyceride-Glucose (TyG) index before coronary angiogram might help with risk assessment and selection of treatment strategy. Objective: To evaluate the association of Triglyceride-Glucose (TyG) index with severity of CAD determined by SYNTAX score in patients with ACS. Methods: This cross-sectional study was done in the department of Biochemistry of Sir Salimullah Medical College from March 2024 to February 2025. A total 224 patients with ACS undergoing coronary angiography were enrolled as study subjects by purposive sampling. TyG index was calculated from fasting plasma glucose and fasting serum triglycerides level. Subjects were grouped according to the tertile of TyG index into tertile 1 (T1), tertile 2 (T2) &amp; tertile 3 (T3). A SYNTAX score of ≤22 was considered as not severe and a SYNTAX score of &gt; 22 was considered as severe CAD. Severity of CAD was compared among different tertile groups by chi square test. Association of high TyG Index with severity of CAD was determined by odds ratio (OR). The correlation of TyG Index with severity of CAD was determined by Pearson’s correlation coefficient test. The cut off point of TyG index was determined by Youden’s Index. The diagnostic role of TyG index for detection of severe CAD was determined by Receiver operator characteristic (ROC) curve, the area under (AUC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. P-value ≤0.05 was considered statistically significant. Results: Among 224 subjects divided into TyG index tertiles, the highest tertile (T3) was strongly associated with a high SYNTAX score (&gt;22), and subjects with high TyG index (&gt;8.47) found to have 37.83 times more risk to have severe CAD (OR= 37.83, CI:17.06-84.0). The TyG index showed a significant positive correlation with the SYNTAX score (r=0.880, p&lt; 0.001). Receiver operating characteristics (ROC) curve analysis of TyG index (cut-off point 8.47) for predicting severe CAD showed the area under curve (AUC) to be 0.99, sensitivity 76.5%, specificity 92.0%, PPV 88.0%, NPV 83.5% and accuracy 85.0%. Conclusion: High TyG index was associated with increased severity of coronary artery disease in ACS patients. High TyG index was a good predictor of severe CAD with high sensitivity , specificity, diagnostic accuracy and AUC. Bangladesh Medical Res Counc Bull 2025;51(3): 145-150

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&gt;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&lt;0.001). VAS scores also demonstrated significantly greater pain reduction in Group A at both follow-ups (p&lt;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

RESUMO:Este trabalho analisa a relao entre prticas de ESG (Ambiental, Social e Governana) e estratgias de marketing sustentvel, destacando sua relevncia para a reputao corporativa e o desenvolvimento de um capitalismo mais sustentvel.O objetivo compreender como essas prticas podem ser integradas para gerar impacto positivo tanto para as organizaes quanto para a sociedade, abordando a importncia da transparncia e autenticidade no contexto de crescentes demandas de consumidores e investidores por responsabilidade socioambiental.A metodologia adotada baseia-se em pesquisa bibliogrfica, com reviso de literatura acadmica sobre ESG e marketing sustentvel e anlise do relatrio empresarial da Natura &Co.Essa abordagem permitiu identificar as tendncias, desafios e boas prticas relacionadas comunicao empresarial e implementao de estratgias alinhadas aos princpios do desenvolvimento sustentvel.Conclui-se que a integrao efetiva de prticas ESG com aes de marketing no apenas melhora a reputao e competitividade das empresas, mas tambm contribui para a construo de um modelo econmico mais alinhado s necessidades do planeta e da sociedade.Contudo, o estudo destaca a necessidade de um aprimoramento contnuo na transparncia das comunicaes corporativas e na adaptao a um cenrio global dinmico, reforando o papel central do marketing na disseminao de prticas empresariais sustentveis e autnticas.

Background: The establishment of complete enteral nutrition is a significant difficulty in the management of preterm low birth weight (LBW) infants. Probiotics are live microbial supplements that populate the gut with favorable flora, increase feeding tolerance, and encourage the expansion of these premises. The aim of the study is to observe probiotics’ activity in improving immunity in preterm, low birth weight neonates. Materials and methods: This randomized controlled clinical trial was carried out in the Department of Paediatrics, Abdul Malek Ukil Medical College &amp; Jononeta Nurul Hoque Adhunik Hospital, Noakhali during January to December 2023. A total of 130 LBW infants were included in this study. Selected infants were randomly allocated to either probiotic groups (n=65) or control groups (n=65). Collected data were classified, edited, coded and entered into the computer for statistical analysis by using SPSS-23. Results: The average initiation of feeding was 4.3±1.0 days in the probiotics group and 4.5±0.9 days in the control group. Probiotics significantly decreased the time to full enteral feed and hospital stay compared to the control group. In the probiotics group, the mean duration of postnatal antibiotics was 9.89±2.6 days, while in the control group, it was 10.87±2.8 days. Ninety-six (96.72%) patients in the control group and 100% patients in the probiotics group had necrotizing enterocolitis stage II or lower. Five (5) patients (10%) in the control group and 3 (6%) in the probiotics group were found to be infected more than 3 days after birth. Conclusion: Probiotic supplementation in preterm low birth weight infants improves feed tolerance, decreases hospital stay, reduces the risk of infection and improves weight gain in comparison to non-supplement group. Eastern Med Coll J. July 2025; 10 (1): 23-28

Background: Association of Vitamin D receptor gene single nucleotide polymorphism and its association with various diseases have been previously researched, but its association with chronic obstructive pulmonary disease (COPD) has not been investigated yet. Objective: To evaluate the association between vitamin D receptor gene polymorphism (ApaI) and COPD. Methods: This study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2019 to February 2020. For research, pulmonologists diagnosed 15 (fifteen) COPD patients with age 40 to 80 years (post-bronchodilator FEV1/FVC &lt;0.70 and FEV1 &lt;80% predicted) and 15 (fifteen) apparently healthy age-matched individuals (for comparison), were selected. The genetic assessment of (ApaI) was assessed by PCR-RFLPs. Data were stated as mean ± SD and percentage. The Independent sample‘t’ test and chi-square test were done for statistical analysis. In the interpretation of the results, ≤ 0.05 level of probability (p) was accepted as significant. Results: The frequency distribution of the ApaI VDR SNP was 20% (AA), 80% (Aa), 0% (aa) and 46.67% (AA), 40% (Aa), 13.33% (aa) COPD patients and healthy subjects, respectively. Furthermore, the AA (OR 0.28, 95% Cl 0.05-1.44, p = 0.12) and aa (p=0.14) were not associated with COPD. However, the heterozygous SNP of ApaI, Aa (OR 6, 95% CI 1.17-30.72, p = 0.02) was significantly associated with COPD. Conclusion: This study showed that ApaI of VDR SNP is associated with COPD. Eastern Med Coll J. July 2025; 10 (1): 33-39

Appendiceal mucocele (AM) is a lesion of the appendix, characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It may be caused by benign or malignant diseases. AM is a rare condition, encountered in only 0.1-0.4% of all appendectomies with a female predominance. Clinically it can remain either asymptomatic for long time or it can manifest with abdominal pain that can be associated with the presence of a palpable mass. The most common clinical manifestation is pain in the right iliac fossa. Preoperative diagnosis is rare, while it is more frequently intraoperative. Therapy is fundamentally surgical. We report the case of a 10-year male with right lower abdominal pain, anorexia and low-grade fever. A complete blood count, urine routine examination and ultrasonogram of the whole abdomen Eastern Med Coll J. July 2025; 10 (1): 81-83

Background: Thyroid dysfunction is widely reported to be more prevalent in patients with type 2 diabetes mellitus (T2DM) across different regions of the world; however, there is limited data available on this in our local context. The present study aimed to evaluate the thyroid dysfunction in patients with T2DM and find out the relationship with HbA1c. Materials and Methods: This cross-sectional study was carried out in Eastern Medical College Hospital from June 2024 to November 2024. Sixty (60) diagnosed type 2 diabetic patients and Sixty (60) nondiabetic people with the age range of 31 to 70 years were taken by convenience sampling. Permission for the study was taken from the IERB of EMC. Informed consent was obtained from each participant prior to sample collection. Patients with type 1 diabetes, gestational diabetes, thyroid cancer, thyroid surgery, renal and liver failure were excluded from the study. All the data was processed and analyzed using Microsoft Excel and IBM-SPSS v25.0. Results: The mean age was 48.55±8.6 years in the diabetic group and 42.41±9.8 years in the non-diabetic group). Serum TSH and FT3 were significantly higher in type 2 diabetic patients than those of non-diabetic people in this study. But there was no significant difference in serum FT4 between two groups. Among type 2 diabetic cases, 12 (20%) had thyroid dysfunction and in non-diabetics, 05 (8.2%) had thyroid dysfunction. Among cases 5 (8.3%) had hypothyroidism, 6 (10%) had subclinical hypothyroidism, 1 (1.6%) had hyperthyroidism. Among non-diabetic subjects 1 (1.6%) had hypothyroidism, 3 (5%) had subclinical hypothyroidism, 1 (1.6%) had hyperthyroidism. There was a positive significant correlation of HbA1c with TSH and FT3 but not with FT4 in the study cases. Conclusion: Diabetic complications and diabetes-related metabolic and demographic factors are related to abnormal thyroid hormone levels. Therefore, routine testing of thyroid hormones in diabetic patients is essential, as it can aid in the early detection of thyroid-related complications. Eastern Med Coll J. July 2025; 10 (1): 51-56