National Institute of Cancer Research and Hospital

Background: Breast cancer remains significant health concern across the world and the leading cause of cancer related mortality and morbidity among females. Various trials have been performed to evaluate the chances of less extensive surgery in both breast and axilla, even omission of axillary surgery. So, it is paramount to identify the prognostic and predictive factors that may fulfill the goal in the future. Methods: This was a cross-sectional observational study which took place in the Department of Surgical Oncology, National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka from January 2023 to December 2023 over a period of 12 months. A p<0.05 was considered statistically significant. Results: A total number of 76 patients were enrolled in the current study after fulfilling the inclusion and exclusion criteria. Mean age of the study population was 42.37±9.87 years. There is statistically significant relationship between tumor size and ALNM (p<0.05) where majority of the patients (n=47) presented with T2 lesion (61.84%). Results of the study also showed involved site of breast by cancer was significantly related to axillary lymph node metastasis (ALNM). The number of patients presented with upper and outer quadrant, Upper and Inner quadrant and lower and inner quadrant were 48 (63.2%), 13 (17.1%) and 6 (7.9%) respectively. Lower and outer quadrant was involved by 8 (10.5%) patients which was not significantly related with ALNM (p>0.05). Conclusions: The current study demonstrated quadrant involvement can emerge as a clinically useful prognostic factor in breast cancer as there is a higher incidence of lymph node positivity with increasing size of the breast tumor and for tumors located at the outer quadrants of the breast. So, the site of primary tumor and size may be an important characteristic finding affecting the prognosis and treatment of patients with breast cancer.

Background: The supraclavicular brachial plexus (SBPB) block is widely used for upper limb surgeries. Adding adjuvants such as dexamethasone and clonidine to bupivacaine may enhance its efficacy. This study evaluates and compares these adjuvants in terms of improved peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia block, postoperative analgesia. Objective: This study was designed for the evaluation of the effectiveness of dexamethasone versus clonidine as an adjuvant to bupivacaine for ultrasound-guided supraclavicular brachial plexus block in patients undergoing upper limb surgery. Materials and Methods: This randomized controlled trial was conducted on 75 adult patients undergoing upper limb surgeries at Dhaka Medical College Hospital. Patients were divided into three groups: Group A (bupivacaine + normal saline), Group B (bupivacaine + dexamethasone), and Group C (bupivacaine + clonidine). Outcomes assessed included onset and duration of sensory and motor block, time for first demand of analgesia and total consumptions of analgesics within 24 hours, haemodynamic parameters, adverse effects were observed among three groups. Data were analyzed using ANOVA and t-tests, with statistical significance set at p<0.05. Results: The demographic profiles were similar in three groups (p value >0.05).The time for complete sensory block was 23.6±3.1, 18.9±3.2 and 14.7±3.0 minutes and time for the onset of maximum motor level was 29.5±3.9, 23.5±3.1 and 20.8±2.4 minutes in Group A, B and C respectively. These are significantly less in clonidine (group C) group compared to normal saline (group A) and dexamethasone (group B) group (p<0.05). The Ramsey sedation score (RSS) was higher in group C in first eight hours during postoperative periods than two other groups which was also statistically significant (p value <0.05). The time to regression of sensory block was 242.1±16.57, 932.9±44.9 and 739.16 ±13.47 minutes and motor block was 175.6±17.5, 780.8±26.2 and 570.6 ±22.0 minutes in groups A, B and C respectively. It was significantly longer in group B than in other two groups which was statistically significant (p value <0.05). Similarly in comparison to other two groups, group B had significantly increased time for motor recovery (190.8±18.3, 810.6±25.8 and 600.6±24.9 minutes in groups A, B and C respectively with p value <0.05). On the other hand, group B had significantly longer time for 1st demand of analgesic (260.6±23.0, 975.2±29.0 and 760.8±25.5 minutes in groups A, B and C respectively), significantly decreased total analgesic requirements in 24 hours (232.8±15.5, 84.7±13.8 and 166.1±19.4 mg in groups A, B and C respectively) and also significantly decreased total anti-emetic requirement in 24 hours (11.8±0.3, 4.1±0.8 and 8.0±0.0 mg in groups A, B and C respectively with p value <0.05). All over adverse effects were significantly less in group B compared to group A and group C (p value <0.05). Conclusion: Dexamethasone is superior to clonidine as an adjuvant to bupivacaine in terms of prolonged analgesia and fewer side effects, making it a better choice for ultrasound-guided supraclavicular brachial plexus blocks. J Enam Med Col 2023; 13(1): 10-21

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.

Hydatidiform mole (HM) is a gestational trophoblastic disease characterized by abnormal proliferation of trophoblastic tissue. Accurate subclassification into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) is essential, as CHM carries a higher risk of persistent trophoblastic disease and choriocarcinoma. Histopathology alone may be inconclusive due to overlapping features and interobserver variability. p57 immunohistochemistry has emerged as a valuable ancillary tool in differentiating CHM from PHM. This study aimed to evaluate p57 expression across histopathologically diagnosed cases of HM and determine its usefulness as a diagnostic marker. A cross-sectional observational study was conducted on 57 cases diagnosed as complete, partial, or indeterminate HM from the Bangladesh Medical University (BMU) and private laboratories in Dhaka. All cases were re-evaluated based on defined histopathological criteria. p57 immunohistochemistry was performed in the Department of Pathology, BMU, and staining results were compared across diagnostic groups. Statistical analysis was performed using SPSS Statistics version 22.0 for Windows (IBM Corp., Armonk, NY, USA). A p value <0.05 was considered significant. Results: Of 57 cases, 36 were histologically diagnosed as CHM, 13 as PHM, and eight as indeterminate. Among CHM, 32 (88.9%) showed negative p57 expression, while four (11.1%) were positive. In PHM cases, nine (69.2%) showed positive expression, and four (30.8%) were negative. Among indeterminate cases, six showed negative expression, and two were positive. p57 expression demonstrated a statistically significant association with final diagnosis, leading to reclassification of cases to 42 CHM and 15 PHM. p57 immunostaining significantly enhances diagnostic accuracy and reduces ambiguity in differentiating complete from partial HM. Incorporation of p57 evaluation alongside histopathology is recommended for reliable subclassification of HM.

Traditional non-surgical periodontal therapy (NSPT) is based on debriding supra-gingival and sub-gingival calculus and providing advice regarding oral health care techniques. Chlorhexidine is used as a mouthwash to prevent plaque and bacterial accumulation. Honey is used to treat periodontitis, inflammation of the gingiva, plaque development, and odor management. A quasiexperimental study was conducted in the Department of Dental Pharmacology, Department of Periodontology, and the Outpatient Department of Dentistry of Bangladesh Medical University (BMU), Dhaka, Bangladesh, between January and December of 2024, to evaluate the efficacy of honey comparing to chlorhexidine mouthwash in non-surgical periodontal therapy. A total of 66 participants were enrolled in this study based on inclusion and exclusion criteria. Among them, 33 participants were in the intervention group (treated with honey), while the rest 33 participants were in the control group (treated with chlorhexidine mouthwash). Oral health status, periodontal condition, and other study-related information were collected through a data collection sheet. Probing pocket depth (PPD) was measured at baseline, 3 months, and 6 months to compare outcomes in both groups to compare the efficacy of honey and chlorhexidine. Participants of the control group had a mean age of 39.7±13.2 years, while the participants of the intervention group had a mean age of 40.5±11.7 years. A male predominance was observed in both groups with 19(57.6%) and 20(60.6%) male patients respectively. Regarding PPD, at baseline examination, there was no difference between two groups (3.35±0.67 vs. 3.14±0.56; p=0.19). However, after 3 months (3.07±0.91 vs. 2.65±0.68; p=0.04) and after 6 months (3.03±1.13 vs. 2.43±0.91; p=0.02), statisticaly significant differences were observed. Overall, honey worked better than chlorhexidine to reduce probing pocket depth. Moreover, adverse drug reactions were observed more in the control group (39.4%) than that of the intervention arm (9.1%) (p=0.004). Honey’s natural antimicrobial and anti-inflammatory properties contributed to significant reductions in probing pocket depth (PPD) and showed less adverse effects compared to chlorhexidine mouthwash. Mugda Med Coll J. 2025; 8(2): 145-149

Pain management is crucial in treating chronic conditions, and screening for neuropathic pain is important due to its distinct management compared to nociceptive pain. Simple screening questionnaires play a key role in patient management and clinical research. This study aims to translate and adapt the English version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale into Bengali, followed by standard validation. The study was conducted in 2 phases. Four independent translators performed forward and backward translations of the English LANSS pain scale into Bengali. The Bengali version was finalized after expert committee reviews and cognitive debriefing. The final validation was carried out among 191 patients with chronic pain. In the last phase, the validity (construct, and discriminant validity) and reliability (interclass item-wise correlation coefficient) of the translated tool were evaluated. The Bengali version demonstrated a high reliability (α = 0.85 and rSB = 0.92). Exploratory factor and confirmatory factor analysis revealed a three-factor structure. ROC analysis showed the highest sensitivity (94.6%) and specificity (93.4%) at a cutoff value of 9.5. Additionally, the agreement between the clinical assessments and the Bengali version of the LANSS pain scale diagnosis indicated almost perfect agreement (κ = 0.84). The Bengali version of the LANSS pain scale exhibits high reliability and validity for assessing neuropathic pain in Bengali-speaking populations.