Women Medical College

INTRODUCTION: A uterine isthmocele is a pouch-like defect at a prior cesarean scar, also called a niche or cesarean scar defect. Estimates of the incidence of an isthmocele range from 20% to 80% among those with a prior cesarean delivery, with approximately 1/3 of patients becoming asymptomatic. An isthmocele may cause abnormal uterine bleeding, pelvic pain or dysmenorrhea, or secondary infertility. In pregnancy, an isthmocele may lead to cesarean-scar ectopic pregnancy, abnormal placentation, or uterine rupture. OBJECTIVE: In this video, we present a clinical case of a large, symptomatic uterine isthmocele. We demonstrate surgical techniques to facilitate laparoscopic hysterectomy in the setting of a complex isthmocele. METHODS: Our submission is a surgical video. RESULTS: Our patient is a 48-year-old G2P2 who initially presented to the emergency department with acute-onset left lower quadrant pain, nausea, and vomiting. Her past history was notable for two prior cesarean deliveries, tubal ligation, and an endometrial ablation. She initially went to the OR with general OB/GYN urgently due to concern for possible ovarian torsion. In the OR, she was noted to have normal-appearing bilateral ovaries and a bulge extending from the uterus into the left broad ligament. The patient was ultimately referred to minimally invasive gynecologic surgery and underwent a scheduled total laparoscopic hysterectomy, bilateral salpingectomy, cystoscopy with insertion and removal of ureteral stents. During the operation, the retroperitoneum was entered, a ureterolysis was performed, and the uterine artery was ligated at its origin. Ultimately, the case was successfully completed with minimal blood loss, and the patient was discharged home on the day of surgery. CONCLUSIONS: In conclusion, uterine isthmocele is a common yet under-recognized clinical entity. While often asymptomatic, they may present acutely with pain, abnormal uterine bleeding, or complicate future pregnancy. Here, we present a case of a patient with acute-onset pelvic pain and large uterine isthmocele, who ultimately underwent hysterectomy with a minimally invasive approach. For patients with complex uterine isthmoceles, knowledge of retroperitoneal anatomy and use of avascular surgical spaces is critical to the success of the operation. Surgeons should consider cytoscopic stent placement to aid in ureterolysis as well as ligation of the uterine artery at its origin to reduce blood loss.

Background: Depression is one of the leading causes of human disability worldwide. Among vulnerable groups, medical professionals are disproportionately effect by depression.Almost 1 in 4 medical students, especially female, suffers from depression worldwide. Ironically, 80% of these cases are reported from low and middle income countries.This can impact not only the health of the sufferer but also all of those who receives medical care from them.Methods: This cross sectional study was conducted in Ad-din Sakina Women’s Medical College, Jasore. One hundred seventy seven participants including students of different batches and Intern doctors were enrolled by convenience sampling in this study. A self administered form including nine item Patient Health Questionnaire (PHQ-9) was used to collect data from September 2024 to April 2025. SPSS was used to run the statistical analayis.Results: Overall 85.3% of participants were found to be in depressive spectrum with 10.7% falling into the category of severe depression. The highest mean PHQ-9 was found among fourth year students (14.48±5.17) and in the 24-26 year-old age group (11.66±5.9).The response “Feeling tired or having little energy” was reported mostly (34.5%) amidst the nearly everyday category followed by Feeling bad about yourself – or that you are a failure or have let yourself or your family down” (31.1%). 11.3% despondence had suicidalideation.Conclusion: The staggeringly high proportion of depressive symptoms should raise the alarm to take mental health of medical students and interns seriously. Every institute should have means to screen and diagnose depression and take actions accordingly to avoid the negative impacts of the condition including planned or completed suicide. J MEDICINE 2026; 27(1): 21-26

Background: Benign urological lesions in adults are frequently encountered in clinical practice and include renal angiomyolipoma, benign renal masses, and selected symptomatic benign proliferative conditions managed within urology. Although these lesions are non-malignant, they may still cause hemorrhage, pain, obstructive symptoms, diagnostic uncertainty, and treatment-related loss of organ function. Contemporary management has shifted toward more selective intervention and greater emphasis on nephron preservation, but the evidence remains fragmented across lesion types and treatment pathways. Objective: To systematically evaluate current diagnostic approaches and management strategies for benign urological lesions in adults, with emphasis on diagnostic utility, symptom outcomes, complications, lesion progression, recurrence, and preservation of organ function. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science were searched for studies published between January 2014 and March 2024. Eligible studies included adults with radiologically characterized or histologically confirmed benign urological lesions and reported diagnostic or management outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality using RoB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Eight studies involving 1,427 adults were included. Five studies evaluated renal angiomyolipoma, two examined benign small renal masses, and one assessed symptomatic benign prostatic proliferative disease. Active surveillance was safe for most small asymptomatic angiomyolipomas, with 94% showing no clinically meaningful growth over 36 months in one prospective cohort and 60% of tuberous sclerosis complex-associated cases remaining intervention-free over 5 years. For larger or symptomatic angiomyolipomas, selective arterial embolization preserved renal function better than partial nephrectomy, with a smaller decline in estimated glomerular filtration rate at 12 months (-3.2 vs -11.5 mL/min/1.73 m²; p<0.01), although post-embolization syndrome was more frequent. Percutaneous biopsy for indeterminate small renal masses showed 88% sensitivity, 100% specificity, and a 15% non-diagnostic rate. Conclusion: Current evidence supports surveillance for selected small asymptomatic renal angiomyolipomas and selective arterial embolization as an effective kidney-preserving option for larger or symptomatic lesions. However, the evidence base is predominantly observational and heavily renal-focused, underscoring the need for higher-quality prospective comparative studies across the broader spectrum of benign urological lesions.

Post-infectious bronchiolitis obliterans (PIBO) is a rare but severe chronic airway disease in children. It usually follows a severe viral lower respiratory tract infection in early life. Persistent inflammation and fibrotic remodeling of the small airways lead to narrowing, air trapping, and progressive loss of lung function. In recent years, reports from countries with high childhood infection burdens, particularly in Asia and Western countries, have drawn more attention to this condition. However, PIBO often remains under-recognized because its symptoms resemble asthma or other chronic lung diseases. This review summarizes available evidence on the epidemiology, risk factors, pathogenesis, clinical features, diagnosis, and management of PIBO in children. Literature was reviewed from published pediatric studies and case series across different regions. Several studies highlight hypoxemia and prolonged mechanical ventilation as strong predictors of disease. Recurrent viral infections, bacterial co-infections, and environmental exposures appear to increase vulnerability. The pathogenesis involves epithelial injury with neutrophildriven in ammation and fibrosis, eventually producing fixed airway obstruction. Clinically, affected children present with a chronic cough, wheeze, tachypnea, and persistent hypoxemia that do not respond to bronchodilators. High-resolution computed tomography (HRCT) is considered the most reliable imaging tool, frequently showing mosaic attenuation, bronchiectasis or air trapping. Lung function testing usually confirms irreversible obstruction. Management remains largely supportive. Systemic corticosteroids, azithromycin, and some immunomodulatory approaches have been tried with variable outcomes. What is clear is that earlier recognition and intervention can help slow progression. More collaborative research is still needed before consistent pediatric guidelines can be developed. The Journal of Ad-din Women's Medical College; Vol. 13 (2), July 2025; p 47-50

Background: Breast cancer, a leading malignancy in women, is influenced by hormonal and reproductive factors. Early menarche and late menopause increase breast cancer risk due to prolonged estrogen exposure. Objective: To investigate associations between reproductive factors (early menarche, late menopause) and breast cancer risk. Methods: This cross-sectional study at Dhaka Medical College (June 2023 to May 2024) included 32 breast cancer patients. Data were collected via questionnaires and medical records. Statistical analysis was performed using SPSS version 26. Ethical approval and informed consent were obtained. Results: The study included 32 participants with a mean age of 45.2 ± 10.5 years. Early menarche (≤11 years) was observed in 28.1%, and 56.2% were postmenopausal. A positive family history was reported in 37.5%, with 58.3% having an affected mother. Ductal carcinoma (75.0%) was the most common histological type, and 62.5% were ER-positive. Most cases were diagnosed at Stage II (37.5%) or Stage III (28.1%), emphasizing late detection. Conclusion: This study underscores the role of reproductive factors and family history in breast cancer risk, emphasizing the need for early screening. Mediscope 2026;13(1): 16-21

BACKGROUND: Subfertility, a growing global issue, arises from diverse gynecological factors including pelvic pathologies. While laparoscopy is the diagnostic gold standard, it is invasive and costly. Transvaginal ultrasonography (TVS) offers a less invasive, affordable alternative, yet its diagnostic accuracy for pelvic pathology in subfertile women requires validation.Aim:To assess and compare the detection of gross pelvic pathology in subfertile women by TVS and laparoscopy.Materials and Method:This cross-sectional study enrolled 100 subfertile women aged 20–40 years at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, from January to December 2015. All underwent TVS followed by diagnostic laparoscopy. Data collection included clinical examination, sonography, and surgical findings.Results: The study included women aged 20–40 years, predominantly between 26 and 35 years. Among them, 61% had primary and 39% had secondary subfertility. TVS identified a normal uterus in 66% and fibroids in 14% of cases, comparable to laparoscopy findings (76% normal uterus, 14% fibroids). TVS detected normal ovaries in 56% and polycystic changes in 32%, while laparoscopy detected 40% and 38%, respectively. Fallopian tubes were visualized in 96% by TVS and 84% by laparoscopy. However, TVS failed to detect peritubular adhesions visible in 14% by laparoscopy. Hydrosalpinx was observed in 4% by TVS and 2% by laparoscopy. Pouch of Douglas abnormalities and endometriosis were underdiagnosed by TVS compared to laparoscopy. Overall, TVS demonstrated a sensitivity of 62.87%, specificity of 81%, positive predictive value of 89%, and negative predictive value of 49% in detecting pelvic pathology.Conclusion:TVS is a valuable, noninvasive tool for detecting uterine and some ovarian pathologies in sub-fertile women. Yet, it has limitations in detecting tubal and peritoneal disease, emphasizing that laparoscopy remains necessary for definitive diagnosis in complex cases. J Med Coll Women Hosp.2026; 22(1): 42-52

Leadership is increasingly recognized as a core professional competency in undergraduate medical education, yet existing training remains inconsistent in structure and depth. Recent studies show considerable variation in how leadership is taught and evaluated, making it difficult for medical schools to define effective educational strategies. Objectives: To synthesize contemporary evidence on teaching methods, curricular structures, and reported outcomes of leadership training for undergraduate medical students (2017–2024). Methods: A systematic search of PubMed, Scopus, and the Cochrane Library (2017–2024) identified original research involving undergraduate medical students. Eligible studies reported a leadership-related intervention, perceptions, or readiness. Data extraction focused on teaching approaches, duration, assessment tools, and reported learning outcomes. Study quality was appraised using MMAT and JBI checklists. Results: Fifteen studies met the inclusion criteria. Most interventions were short workshops, brief courses, or needs-assessment surveys, with only a few longitudinal or integrated curricula. Common pedagogical methods included interactive workshops, reflective activities, team-based tasks, and student-led sessions. Outcomes largely reflected self-reported improvements in communication, teamwork, and confidence, while evidence of behavioural change or objective performance was limited. Considerable inconsistency existed in outcome measures and leadership competencies assessed. Conclusion: Current evidence indicates growing attention to leadership training but highlights significant gaps in curricular structure, assessment tools, and long-term evaluation. Programs using blended, experiential, and repeated learning opportunities show promise, but more rigorous, longitudinal, and competency-based approaches are needed to establish effective leadership development in undergraduate medical education.

Background: breast cancer represents a significant global health burden, with a complex etiology extending beyond genetic predisposition to encompass modifiable lifestyle and environmental exposures. A myriad of these factors are frequently discussed in both scientific and public domains, yet the evidence supporting these associations varies widely in strength and consistency. Objective: This narrative review aims to broadly survey and synthesize the lifestyle and environmental factors that are casually mentioned in relation to breast cancer development, providing a panoramic overview of these superficial associations without delving into deep mechanistic analysis. Main Discussion Points: The review thematically explores factors including dietary patterns, alcohol and tobacco use, physical activity, body composition, exogenous hormones, environmental chemical exposures, circadian disruption, and socioeconomic influences. It highlights well-established causal links, such as those for alcohol and postmenopausal obesity, while also presenting the more ambiguous and inconsistently supported associations for elements like specific dietary components and endocrine-disrupting chemicals. Critical analysis underscores the methodological limitations inherent in the observational evidence base. Conclusion: The evidence for casually mentioned risk factors exists on a spectrum, with clear public health priorities emerging for risk reduction. Clinicians and policymakers should focus on advocating for interventions related to the most robustly evidence-based factors. The review calls for future research employing more rigorous, integrative study designs to clarify unresolved associations and advance primary prevention strategies.

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with diverse clinical presentation, predisposing factors, brain imaging findings, and outcome. Objectives: The objective of the study was to evaluate the risk factors associated with cerebral venous sinus thrombosis and hospital outcome of patients treated conservatively with medical management. Methodology: This prospective observational study was conducted in the inpatient department of neurology at national institute of neurosciences and hospital, Dhaka, Bangladesh over a period of 18 months, from June 2017 to December 2018. Total 50 Patients fulfilling the inclusion & exclusion criteria, were included in this study. All the study patients were evaluated clinically and routine laboratory investigation, specific investigation to confirm the diagnosis of venous sinus thrombosis along with special investigation to find out possible risk factors were done. All patients after diagnosis of venous thrombosis medical treatment with LMWH were given. Results: A total of 50 patients of CVST were included with age more than 18 years. Among them 34 (68%) were females and 16 (32%) were males with average age 28.48 ± 9.55 years in both sexes. Out of 50, 48(96%) patients were presented with symptoms of headache, of total 44(88%) had vomiting and 30(42%) had blurring of vision or double vision, 11 (22%) had Seizures, 12(24%) had altered level of consciousness and limb weakness was observed only 10 (20%) patients. Most common risk factors were Oral contraceptive pill (OCP), which was 25 (78.1%) and puerperium 8(23.1%) among females, infections were 11(22%) and no risk factors were found among 11(22%) of study patients overall. Both superficial and deep venous system were involved. Transverse sinus was most commonly involved and was involved 45 (90%) patients. Mean hospital stay was 12.46 days, most of the patient had significant improvement of symptoms and signs during discharge from hospital after treatment, only 4(8%) patients were died. Conclusion: Cerebral venous sinus thrombosis is a uncommon form of stroke, early diagnosis can be made with high degree of clinical suspicion and available neuroimaging, mortality and morbidity can be reduced by early diagnosis and initiation of treatment. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):13-18

Background: Multidrug-resistant (MDR) Pseudomonas aeruginosa in burn wounds is becoming a difficult issue worldwide. The recent emergence of meropenem-resistant MDR Pseudomonas aeruginosa poses a serious threat to public health. The activity of the MDR efflux pump is a key mechanism contributing to meropenem resistance. Objective: The study aims to detect efflux pump phenotypically and genotypically in meropenem-resistant MDR Pseudomonas aeruginosa among burn wound patients. Methods: A total of 120 laboratory isolates of Pseudomonas species from burn wounds were collected from the patients of National Institute of Burn and Plastic Surgery, Dhaka. The automated VITEK® 2 Compact system in the department of microbiology and immunology at Bangladesh Medical University (BMU) was used to identify Pseudomonas aeruginosa. Antimicrobial susceptibility testing and identification of MDR Pseudomonas aeruginosa were conducted by using the Kirby-Bauer disk diffusion technique. Out of 120 laboratory isolates of Pseudomonas species; Pseudomonas aeruginosa accounted for the majority of these isolates (109, 90.8%), followed by Pseudomonas fluorescens (6, 5%) and Pseudomonas putida (5, 4.17%). Among 109 Pseudomonas aeruginosa, 92 (84.4%) were multidrug resistant (MDR). Among 92 MDR cases, 78 (84.8%) were meropenem-resistant Pseudomonas aeruginosa. Finally, 78 meropenem-resistant Pseudomonas aeruginosa among all MDR were selected as study subjects. Efflux pump that causes meropenem resistance was identified both phenotypically and genotypically. Ethidium bromide cartwheel (EtBr-CW) approach was used for phenotypic identification and efflux pump genes (MexAB-OprM) detection by conventional polymerase chain reaction (PCR) was used for genotypic identification of efflux pump. Result: Out of 109 Pseudomonas aeruginosa isoates, majority (92, 84.4%) of Pseudomonas aeruginosa were multidrug-resistant (MDR) where majority (78, 84.8%) showed resistance to meropenem. Among meropenem resistant Pseudomonas aeruginosa (78); efflux pump was detected both genotypically and phenotypically in 52 (66.7%) cases and only genotypically in 05 (6.4%) cases. Therefore, in 57 (73.1%) cases efflux pump was detected genotypically through detection of efflux pump gene. Among the different efflux pump gene; Mex A gene was found in 52 cases, Mex B gene in 57 cases, Opr M gene in 19 cases, both Mex A and Mex B gene in 51 cases and Mex A, Mex B, Opr M gene together in 19 cases. Conclusion: The majority of pseudomonas aeruginosa were multidrug resistant (MDR) and showed resistant to meropenem. Efflux pump genes (MexA, MexB, OprM) were found in good number of the patients. Bangladesh Medical Res Counc Bull 2025;51(3): 131-138