Square Hospitals

Choanal atresia is a rare congenital obstruction of the posterior nasal aperture. Unilateral choanal atresia may remain undiagnosed until adulthood and typically presents as chronic unilateral nasal obstruction. A 21-year-old female presented with right-sided nasal obstruction and intermittent snoring since childhood. She had undergone adenotonsillectomy at 11 years of age without improvement. Examination revealed septal deviation to the left, right inferior turbinate hypertrophy, and absent right nasal airway patency. Nasal endoscopy identified a right posterior choanal atretic plate, and computed tomography of the paranasal sinuses confirmed complete right-sided mixed choanal atresia. The patient was treated with endoscopic transnasal posterior septectomy and removal of the atretic plate. Recovery was uneventful. Follow-up endoscopy at 1 and 4 months demonstrated a widely patent neochoana with complete symptom resolution. Adult unilateral choanal atresia is uncommon and often misdiagnosed. Clinicians should consider this diagnosis in patients with lifelong unilateral nasal obstruction, and endoscopic transnasal posterior septectomy offers a safe and effective treatment option. Journal of Green Life Med. Col. 2026; 11(1): 30- 32

Abstract Background Beta-lactam antibiotics are among the most commonly prescribed antimicrobials worldwide, but they are also a frequent cause of drug-induced hypersensitivity reactions, ranging from mild rashes to life-threatening anaphylaxis. While clinical trial data provide initial safety signals, rare and delayed adverse events often emerge post-marketing. This study aimed to analyze post-marketing reports of hypersensitivity reactions associated with beta-lactam antibiotics using the U.S. FDA Adverse Event Reporting System (FAERS) database.Forest Plot: Hypersensitivity Signals of Beta-Lactam Antibiotics (FAERS, 2010–2023) This forest plot displays the reporting odds ratios (RORs) with 95% confidence intervals for hypersensitivity-related adverse events associated with beta-lactam antibiotics. Notable signals include: Cefazolin–associated anaphylaxis (ROR 3.89) Angioedema with amoxicillin-clavulanate (ROR 2.97) Urticaria with ceftriaxone (ROR 2.12) All events exceeding an ROR of 1 with lower CI >1 are considered statistically significant safety signals, reinforcing the need for careful antibiotic selection, particularly in sensitized patients. Methods A retrospective pharmacovigilance analysis was conducted using FAERS data from January 2010 to December 2023. Reports involving penicillins, cephalosporins, carbapenems, and monobactams were extracted using generic and brand names. Hypersensitivity-related Preferred Terms (PTs) were identified via the MedDRA hierarchy, including anaphylactic reaction, angioedema, urticaria, erythema multiforme, and DRESS syndrome. Disproportionality was assessed using Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR), with statistical significance defined as ROR 95% CI >1 and ≥3 cases. Results A total of 14,728 hypersensitivity-related adverse event reports were associated with beta-lactam antibiotics. Among them, amoxicillin accounted for the highest number of reports (n = 4,615), followed by ceftriaxone (n = 2,763) and piperacillin-tazobactam (n = 1,980). Disproportionality analysis showed the strongest signal for anaphylaxis with cefazolin (ROR: 3.89, 95% CI: 3.22–4.68) and angioedema with amoxicillin-clavulanate (ROR: 2.97, 95% CI: 2.45–3.61). Cephalosporins were more frequently associated with skin-related hypersensitivity (e.g., urticaria, erythema), whereas carbapenems were linked to a lower but consistent signal for severe reactions. Conclusion This large-scale post-marketing analysis using FAERS data highlights distinct hypersensitivity risk profiles among beta-lactam subclasses. The findings reinforce the need for careful history-taking and individualized antibiotic selection, especially in patients with prior allergy history. Real-world data from spontaneous reporting systems like FAERS remain crucial in identifying emerging safety signals. Disclosures All Authors: No reported disclosures

Abstract Background Severe Cutaneous Adverse Reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), are rare but potentially fatal outcomes of antibiotic exposure. Early identification of drug-specific risk is essential to guide safer prescribing. This study aimed to evaluate and compare SCAR signals associated with commonly used antibiotics using the U.S. FDA Adverse Event Reporting System (FAERS).Forest Plot: SCARs Associated with Antibiotic Use (FAERS 2010–2023)This forest plot presents the reporting odds ratios (RORs) with 95% confidence intervals for severe cutaneous adverse reactions (SCARs) related to commonly used antibiotics. Trimethoprim-sulfamethoxazole showed the strongest signal for SJS/TEN, followed by significant signals for amoxicillin (DRESS), ceftriaxone (AGEP), and fluoroquinolones (SJS). All antibiotics listed demonstrated statistically significant associations, underscoring the importance of hypersensitivity risk profiling in clinical practice. Methods A retrospective pharmacovigilance analysis was conducted using FAERS data from January 2010 to December 2023. Reports mentioning SCAR-related MedDRA Preferred Terms were extracted. Antibiotics assessed included beta-lactams, macrolides, fluoroquinolones, sulfonamides, and tetracyclines. Signal detection was performed using disproportionality analysis—calculating Reporting Odds Ratios (ROR) and 95% confidence intervals (CI). A signal was considered positive if the ROR lower CI exceeded 1 with ≥3 reports. Results A total of 5,294 SCAR-related reports were linked to antibiotic exposure. Sulfonamides, particularly trimethoprim-sulfamethoxazole, showed the strongest signal for SJS/TEN (ROR: 12.84, 95% CI: 10.92–15.11). Beta-lactams—especially amoxicillin and ceftriaxone—were significantly associated with DRESS and AGEP (ROR: 4.31 and 3.62, respectively). Fluoroquinolones demonstrated moderate signals for SJS, while macrolides showed weaker but present associations. The majority of severe cases required hospitalization, and 8.3% resulted in reported death. Conclusion This FAERS-based analysis confirms that sulfonamides and certain beta-lactams carry the highest SCAR risk among antibiotics. The findings support heightened clinical vigilance and risk stratification, especially in patients with known drug allergies or genetic predispositions. Continuous pharmacovigilance is crucial for identifying high-risk agents and improving patient safety in antibiotic prescribing. Disclosures All Authors: No reported disclosures

BackgroundAging leads to physiological decline, increasing the risk of frailty, sarcopenia, and falls, which impact older adults’ physical activity, performance, and quality of life. Exercise is recommended for mitigating these effects, yet the optimal approach remains unclear. This trial will compare two community-based multimodal exercise programs—sensorimotor and strengthening exercise—to evaluate their effectiveness in enhancing physical activity, performance, fall prevention, and quality of life. The findings will guide evidence-based recommendations for promoting functional independence and healthy aging among community-dwelling older adults.MethodsThis trial will be a multicenter, double-blind, parallel, randomized clinical trial in which 140 older adults will be enrolled from July 2025 to May 2026 in Bangladesh. Eligible participants will be allocated into two groups for community-based multimodal exercise programs (CMEPs) at a 1:1 ratio: CMEP-I: sensorimotor exercise group; CMEP-II: strengthening exercise group. The exercise programs will last for 24 sessions/8-week, with a 24-week follow-up. The major outcome measurements will include physical activity, performance, fall prevention, and quality of life using a Physical Activity Scale for the Elderly (PASE), Short Physical Performance Battery (SPPB), Modified Falls Efficacy Scale (MFES), and 36-item Short Form Survey (SF-36). All outcomes will be assessed at pretest, posttest after 8 weeks, and follow-up after 32 weeks.DiscussionThis randomized clinical trial will investigate the comparative effectiveness of sensorimotor and strengthening exercise programs as community-based multimodal interventions for older adults. These findings will provide evidence on nonpharmacological strategies for improving physical activity, performance, fall prevention, and quality of life, particularly in resource-limited settings. The trial’s robust design strengthens validity, although generalizability may be constrained. Long-term follow-up will provide insights into sustained benefits, potentially informing rehabilitation guidelines and policy recommendations to promote accessible, cost-effective exercise interventions for aging populations.Trial registrationThis trial is registered prospectively in the Clinical Trial Registry India CTRI/2025/03/083260. Registered on 24/03/2025.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09245-3.

Background: Medical Thoracoscopy (MT) is a minimally invasive endoscopic procedure that allows almost complete visualization of pleural cavity, collection of appropriate amount of samples and to do necessary work for the treatment of pathologies. MT is gaining popularity world-wide and few centers in Dhaka practicing it. Here, this study observed the utility of MT in a single centre in a single calendar year. Methods: It was a retrospective study done at respiratory medicine center of a tertiary care hospital, Dhaka reviewing records of all cases of medical thoracoscopy (MT) done as a diagnostic and/or therapeutic procedures over one year. After collecting data, we analyzed them to see the indications, pre- and post-procedural status, outcomes and safety of this procedure. Results: Total 16 patients with unexplained pleural effusion were undergone medical thoracoscopy (MT) last year in Square Hospital. All 16 had diagnostic MT and 7 had therapeutic MT as well. Among all 16 patient, 3 patients were from Oncology, 2 from intensive care unit, 1 from gastroenterology unit and 1 from nephrology unit, others were from our inpatients. MT revealed malignancy in 7 cases (43.75%), tuberculosis in 4 (25%), complicated multiloculated empyema in 3 cases (18.75%), hepatic and renal hydrothorax in 1 case respectively. Among malignant cases, bronchial carcinoma predominates, followed by breast cancer (1 patient) and uterus (1 patient). Pleural adhesionolysis and deseptation was done in 5 cases and pleurodesis by talc slurry or poudrage in 4 cases. There was no major adverse effect seen at or after the procedure. Pain due to chest tube was the main adverse-effect which was managed with simple analgesics. One patient had mild reperfusion pulmonary edema which was easily managed with perenteral steroid for 3 days. One patient had bronchopleural fistula which was managed with repeated tetracycline pleurodesis. All patients were managed effectively with only 2 patients shown to have minimal residual effect like pleural thickening. Conclusion: Medical thoracoscopy or pleuroscopy is a safe and very effective procedure for the diagnosis of the primary etiologies of unexplained pleural effusion and their management. J Bangladesh Coll Phys Surg 2025; 43: 277-293

The management of Tetralogy of Fallot (TOF), one of the commonest congenital anomalies, has advanced rapidly and excellent long-term survival were observed. Residual defects like pulmonary valve regurgitations are identified in an increased number as long-term survival increased and requirement for intervention increased worldwide. Although rare in our setting, we performed aortic valve replacement (AVR) with re-do pulmonary valve replacement surgery on a 21-year-old, non-diabetic, hypertensive young male with the diagnosis of moderate to severe aortic regurgitation with stuck pulmonary (mechanical) valve, with status-post intracardiac repair (ICR) for Tetralogy of Fallot (TOF) with aortic valve repair (AVRe) with pulmonary valve replacement (PVR) with closure of ventricular septal defect (VSD). His postoperative recovery was satisfactory and he was discharged symptom free on 6th postoperative day. J Bangladesh Coll Phys Surg 2024; 306: 306-309

Due to protean presentations, poor sensitivity of radiographs and variable reliability of synovial fluid analysis, diagnosis of Calcium pyrophosphate deposition disease (CPPD) is a challenge. This study addressed the diagnostic performance of musculoskeletal ultrasound (MSK-USG) in identifying CPPD features in hyaline cartilage, fibrocartilage, tendon, and synovial fluid. We compared ultrasound findings in CPPD to those in osteoarthritis (OA) and gout and healthy control. In this retrospective exploratory study, MSK-USG performed between February 2022 and July 2023 were reviewed. Patients retrospectively fulfilled the ACR/ EULAR classification criteria 2023 (score ≥ 56) were included (n = 16). Clinical phenotypes included acute CPP arthritis (44%), CPPD with OA (44%), and chronic CPP arthritis (12%). Ultrasound images were evaluated at common CPPD target sites: hyaline cartilage and fibrocartilage of the knee, wrist triangular fibrocartilage, metacarpophalangeal joints, joint capsules, tendons, and synovial membranes. Ultrasound images of CPPD cases were compared to those of OA, gout, and healthy controls. Sensitivity, specificity, and predictive values were calculated for Ultrasound features. Compared to healthy controls, Ultrasound features showed a sensitivity of 94.12% (CI: 71.31–99.85), specificity of 100% (CI: 86.77–100), positive predictive value of 100%, and negative predictive value of 99.59% in diagnosing CPPD. Ultrasound findings in hyaline cartilage showed a sensitivity & a specificity of 100% each. Fibrocartilage involvement showed a sensitivity of 93.75% and specificity of 86.67%. Whereas these figures were lowest for tendons with sensitivity of 12.5% (CI: 1.55–38.35) and specificity of 86.67% (CI: 69.28–96.24), respectively. Compared to OA, sensitivity and specificity were 100% and 93.75%, respectively. Specificity was lower when compared to gout (40%). MSK-USG demonstrated high diagnostic accuracy in identifying CPPD, especially in hyaline cartilage and fibrocartilage. While these findings support the use of Ultrasound as an adjunctive diagnostic tool, particularly in distinguishing CPPD from OA, the small sample size and retrospective design limit generalizability. Prospective studies with larger cohorts and crystal-confirmed cases are needed for validation.

The association between discrete sub-aortic membrane are frequently associated with other sub-aortic anomalies which is reported less often, and till today the surgical correction is considered challenging. An 18-year-old, young lady presented to us with the diagnosis of a discrete sub-aortic membrane producing severe Left Ventricular Outflow Tract Obstruction (LVOTO). We excised the membrane surgically and patient showed excellent symptom free recovery. Per-operative Trans-Esophageal Echocardiogram (TEE) and post-operative Transthoracic Echocardiogram (TTE) showed mild residual membrane and minimum LVOT pressure gradient. JCMCTA 2023 ; 34 (2) : 146-149

Malnourished children may experience disrupted peripheral nerve myelination, leading to impaired nerve conduction. However, ultrasound data on nerve morphology in severely malnourished children are lacking. Therefore, we performed a systematic study, comparing nerve ultrasound in malnourished children to controls. Nerve cross-sectional area (CSA) was assessed in three categories of malnourished (severe acute malnutrition [SAM], stunted, and wasted) and healthy Bangladeshi children aged 6-59 months to compare morphological changes at baseline (pre-intervention) and post-nutritional intervention. A total of 74 children were enrolled, including 17 with SAM, 19 wasted, 18 stunted, and 20 healthy controls. SAM children showed smaller nerve CSA compared to wasted peers, particularly in the sciatic nerve (8.25 mm2 vs. 11.48 mm2, p = 0.035) and median nerve proximal wrist (2.65 mm2 vs. 2.90 mm2, p = 0.004) among 6-23-month-olds. In the 24-59-month group, the median nerve proximal wrist CSA in SAM children was 2.30 mm2 versus 3.90 mm2 in healthy children (p = 0.019), and sciatic nerve CSA was 9.05 mm2 versus 16.60 mm2 (p = 0.008). Nutritional intervention improved z-scores in SAM children numerically, though not significantly within the study period. SAM children had smaller nerve CSA compared with wasted, stunted, and healthy children at specific nerve locations. These findings underscore the substantial impact of SAM on nerve morphology and the importance of early, sustained nutritional interventions, warranting further validation through animal models and large-scale studies in both children and adults.