Original Articles
Evaluation of Ultrasound Guided (USG) Fine Needle Aspiration Cytology (FNAC) and Histopathological findings after Thyroid Surgery
Abstract: Background: Thyroid swelling is a common problem in Bangladesh. Early and systematic evaluation of a nodular thyroid swelling is necessary as it is a frequent presentation of thyroid neoplasia. USG Guided Fine needle aspiration cytology (FNAC) is one of the diagnostic tools for early evaluation of thyroid nodules. USG Guided FNAC is considered as a cost-effective, simple, minimally invasive and easily repeatable procedure for preoperative screening in the diagnosis for most of the thyroid lesions. The objective of this study is to determine the sensitivity and specificity of USG Guided fine needle aspiration cytology (FNAC) and compare the efficacy with histopathology in diagnosis of thyroid swellings. Objective: To evaluate the sensitivity and specificity of USG Guided fine needle aspiration cytology (FNAC) and histopathology for the diagnosis of thyroid swelling. Method: This Observational Prospective Study was performed in the department of Otolaryngology & Head Neck Surgery, Dhaka Medical College Hospital. Dhaka over 6 month’s duration from January 2019-June 2019. Total 50 patients with thyroid swelling was selected after taking informed written consent and fulfilling the inclusion criteria. Smears was taken by standard procedure and then was stained with papanicolaou stain and haematoxylin and eosine stain. The smears was classified into categories like benign, indeterminate, malignant and unsatisfactory. Sensitivity, specificity, positive and negative predictive value and accuracy of USG Guided FNAC was calculated and compared to already available data. Appropriate statistical analysis was done to make comparison between final histopathological findings with initial USG Guided FNAC findings. Result: During the study period a total 73 were found eligible for USG Guided FNAC. Most of the patients (52%) were from 20-39 years age group. Among them 67.12% were female and rest (32.87%) were male. In this government hospital 75.34% were from low income group. According to the findings of USG Guided FNAC nearly half (43.83%) of the patient had Multinodular goiter, Followed by colloid goiter (16.43%). Only 18(24.66%) Patients had carcinoma. From histopathological diagnosis, 55 patient had benign lesion and 18 patients had carcinoma. So the efficacy of USG Guided FNAC of diagnostic tool of solitary thyroid nodule where the sensitivity, specificity, PPV, NPV, PLR, NLR of USG Guided FNAC were 94.73%, 100%, 100%, 98.18%, 0 and 0.052 respectively. Conclusion: This study revealed that this minimal invasive procedure USG Guided (FNAC) had the highest level of specificity which is 100%. The hypothesis of the study was that USG Guided FNAC is the most useful preoperative diagnostic tool in thyroid swelling diagnosis. In this study sensitivity of USG Guided FNAC was found to be 94.73%. Thus we can suggest that in maximum cases the diagnosis is accurate.
- Ahmed Lincoln
- 04 Apr, 2026
Comparing the Efficacy and Safety of Linezolid versus Amoxicillin-Clavulanic Acid in the Management of Moderate to Severe Diabetic Foot Infections
Abstract: Background: Diabetic foot infections (DFIs) represent a major global health challenge, frequently leading to hospitalization, lower extremity amputation, and significant mortality. The choice of empirical antibiotic therapy is complicated by the polymicrobial nature of DFIs and the rising prevalence of multidrug-resistant organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA). This study aimed to compare the clinical and microbiological efficacy of Linezolid, a potent anti-Gram-positive agent, with Amoxicillin-Clavulanic Acid, a broad-spectrum antibiotic, in treating moderate to severe DFIs. Methods: In a prospective, open-label, randomized controlled trial conducted from 2021 to 2023, 300 patients with moderate to severe DFIs were enrolled. Participants were randomized in trial, to receive either Linezolid (600 mg IV/PO q12h) or Amoxicillin-Clavulanic Acid (1.2 g IV q8h or 625 mg PO q8h) for 7-14 days. The primary outcome was clinical cure rate at the test-of-cure visit (14 days after treatment completion). Secondary outcomes included microbiological eradication, incidence of adverse events, and duration of hospital stay. Results: Linezolid demonstrated a significantly higher clinical cure rate compared to Amoxicillin-Clavulanic Acid (85.3% vs. 73.3%, p=0.01). Microbiological eradication was also superior in the Linezolid group (80.0% vs. 66.7%, p=0.02). Subgroup analysis revealed Linezolid’s pronounced efficacy against MRSA (90% vs. 25%, p<0.001), whereas AmoxicillinClavulanic Acid was more effective against Gram-negative pathogens (82% vs. 48%, p=0.003). The overall incidence of adverse events was comparable between groups (22% for Linezolid vs. 18% for Amoxicillin-Clavulanic Acid, p=0.40). Conclusion: Linezolid is a superior therapeutic option for DFIs where Gram-positive bacteria, especially MRSA, are suspected or confirmed. Amoxicillin-Clavulanic Acid remains a valuable agent for polymicrobial infections with significant Gram-negative involvement. Tailoring empirical antibiotic therapy based on local antimicrobial resistance patterns and individual patient risk factors is crucial for optimizing outcomes in DFI management.
- Ahmed Lincoln
- 04 Apr, 2026
Obstructive Sleep Apnoea: Bangladesh Perspective
Obstructive Sleep Apnoea: Bangladesh Perspective
- Ahmed Lincoln
- 04 Apr, 2026
Outcome of Rubber Band Ligation in Treatment of Hemorroids: A study of 50 Cases
Abstract: Background: Hemorrhoids are important today due to rising sedentary lifestyles, poor diets, and stress, leading to increased cases, healthcare costs, and demand for awareness and effective treatments. Objective: My study has a goal to analyze the success of rubber band ligation in hemorrhoids of grade I, II, Ill,to analyze their complication and to see if all symptomatic hemorrhoids should be treated with band ligation at first visit Methods: A prospective and descriptive study was designed for patients who came to OPD of Chittagong Medical College Hospital from July 2007 to June 2008. Patients having large 1st degree hemorrhoids, 2nd degree and early 3rd degree hemorrhoids were treated. Results: Rectal bleeding was the most common symptom (100%). Anoscopy showed 6% first degree, 86% second degree and 8% third degree hemorrhoucis. information on piresentnng symptoms, number of bands applied response to therapy, complications encounteredJ Inumber of sessions needed to improve the symptoms, requirement of analgesks, follow-up of the patients, subsequent therapy were documented. Supplementary information was obtained over telephone follow-up. Outcome was categorized as success or failure in which success has been defined as permanent relief of symptoms within follow-up periods. Improvement in symptomatology means rare manifestation of bleeding(< 1 month). Failure has been defined as decrease but no improvement of symptoms. In this study, 88% patient succeeded, 6% improved and 6% failed. 16% patient had bleeding during defecation < 7 days, 8% patient complaints bleeding > 7 days. Recurrence observed in 2% patients. 38% patients required no analgesics. Among the 62% patients who required analgesics 36.8% required for up to 24-hours, 47.37% required for 24-48 hours and 3- patients needed for > 48 hours. All patient attended first follow-up at 7th day, 14% missed second follow-up at 6 weeks and 16% missed third followup at 6 months. Conclusion: Rubber band ligation is a quick, simple procedure requiring no anesthesia, in absence of anorectal pathologies other than hemorrhoids. Though it has some minor complications and chance of recurrence, it is considered as a safe and effective procedure for symptomatic hemorrhoids.
- Ahmed Lincoln
- 20 Nov, 2025
Comparative Study between Blind Trocar Entry and Hasson Method in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial
Abstract: Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstones. The initial abdominal entry, critical to safety, employs either blind trocar entry (BTE) or the Hasson method. This study compares these techniques in 100 patients. Methods: A single-center randomized controlled trial allocated 100 patients to BTE (n=50) or Hasson (n=50). Outcomes included operative time, complications (visceral/vascular injury, extraperitoneal insufflation), conversion rates, and hospital stay. Statistical analysis used tests and chi-square. Results: Hasson had a longer mean operative time (47.5 ± 8.2 vs. 42.3 ± 6.5 minutes; p=0.001) but fewer major complications, such as Visceral injury (Hasson 0% VS BTE 4% p=0.04 and vascular injury Hasson 0% VS BTE 2%; p=0.32. BTE had higher visceral injury rates (4% vs. 0%, p=0.04). Hospital stay and conversion rates were comparable. Conclusion: The Hasson method reduces complications at the expense of slightly longer operative time, advocating its use in high-risk patients.
- Ahmed Lincoln
- 20 Nov, 2025
Subvastus Approach for Total Knee Arthroplasty : Complete Quadriceps Sparing Technique
Abstract: Background: Minimally invasive approaches are a more recent development, which aims at reducing damage to soft tissues. The subvastus or Southern approach to the knee had been described as early as 1929. This approach for primary total knee arthroplasty (TKA) preserves the integrity of the extensor mechanism and maintains the vascular supply to the patella. It provides excellent exposure of the knee joint with preservation of all peri-articular soft tissues. The benefits of the subvastus approach make it a valuable technique for primary TKA. This combination of advantages ensures rapid recovery, better knee range of motion and finally excellent patient satisfaction. Aim of the study: The goal of this study is to compare the subvastus method to the usual medial parapatellar technique for total knee replacement in patients with osteoarthritis based on quadriceps function recovery in days after surgery. Methods: We retrospectively reviewed case notes of 36 patients with osteoarthritis who had total knee replacements in satkhira medical college hospital and private clinics over the course of a period from August 2019 to August 2024.we evaluated all the cases regarding early postsurgical clinical outcomes (range of motion [ROM], pain on a visual analog scale, and Knee Society Score [KSS]). Preoperative quadriceps strength, BMI, and baseline demographics were all recorded from their initial pre-operative workup case notes. Starting on the first postoperative day, patients recorded first unassisted straight leg raise (SLR) was kept as the main determinant for muscle function. The data were evaluated to determine the quadriceps muscle function post TKR. Result: When compared to the medial parapatellar approach, the quadriceps muscle function returns sooner with the subvastus technique. Patients in their sixties showed the highest improvement. Preoperative quadriceps strength has a major impact on muscle recovery after surgery. Conclusion: The subvastus method to total knee replacement is linked to a faster recovery of quadriceps muscle strength, resulting in a shorter hospital stay and postoperative therapy.
- Ahmed Lincoln
- 20 Nov, 2025
Treatment of Large Bladder Stone by Using Perurethral Nephroscope with Pneumatic Lithotripsy
Abstract: Background: Large bladder stones can cause significant morbidity and typically require active interventions. Pneumatic lithotripsy using a perurethral nephroscope is a minimally invasive and cost-effective treatment option. This study aimed to evaluate the efficacy and safety of treating large bladder stones using a perurethral nephroscope combined with pneumatic lithotripsy. Methods: This cross-sectional study was conducted at Pabna Medical College Hospital and affiliated private hospitals from February 2020 to January 2025. Twenty-three patients with large bladder stones (³3 cm) were enrolled. All patients underwent stone fragmentation using pneumatic lithotripsy with a perurethral nephroscope. Operative time, hospital stay, catheterization duration, and complications were also documented. Data were analyzed using SPSS version 25.0, with significance set at p<0.05. Results: The mean age was 52 ± 12 years, and 87.0% of the patients were male. The average stone size was 4.1 ± 0.6 cm in diameter. The mean operative time was 48.5 ± 12.0 minutes, with an average hospital stay of 1.6 ± 0.5 days. All patients were stone-free after the procedure. Minor complications occurred in 26.1% of the cases, including hematuria (13.0%), urinary retention (8.7%), and fever or stricture (4.3% each). No major complications were noted. Conclusion: Perurethral nephroscopy with pneumatic lithotripsy is an effective, safe, and minimally invasive technique for managing large bladder stones, particularly in resourcelimited settings.
- Ahmed Lincoln
- 20 Nov, 2025
Comparative Study between Primary Skin Closure and Delayed Skin Closure in Appendicular Abscess Drainage: A Randomized Controlled Trial
Abstract Background: Appendicular abscesses are a common complication of acute appendicitis, often requiring surgical drainage. The optimal method of skin closure post-drainage remains debated. This study compares primary skin closure (PC) and delayed skin closure (DC) in terms of surgical site infection (SSI), hospital stay, wound healing time, and patient satisfaction. Methods: A single-blind randomized controlled trial was conducted on 200 patients with appendicular abscesses confirmed via ultrasound or CT scan. Patients were randomized to PC (immediate closure) or DC (closure after 48 hours of open packing). Outcomes included SSI rates (CDC criteria), hospitalization duration, time to complete healing, and patientreported outcomes. Results: The DC group had significantly lower SSI rates (8% vs. 18%, p=0.02) but longer hospital stays (5.8 vs. 3.2 days, p<0.001) and healing times (14.5 vs. 10.2 days, p=0.01). Diabetic patients in the PC group had a 30% SSI rate compared to 12% in DC (p=0.04). Patient satisfaction was higher in PC due to faster recovery. Conclusion: Delayed closure reduces SSI risk, particularly in high-risk populations, but prolongs recovery. Primary closure is advantageous in low-resource settings or for patients prioritizing shorter hospitalization.
- Ahmed Lincoln
- 09 Sep, 2025
Impact of Parathyroidectomy on Quality of Life and Symptom Relief in Primary Hyperparathyroidism Patients
Abstract: Background: Primary hyperparathyroidism is a frequent endocrine disorder with variable clinical manifestation and outcome. This study aimed to evaluate the impact of parathyroidectomy on quality of life and symptom relief in primary hyperparathyroidism patients. Materials and Methods: A Cross sectional study was conducted in the Head and Neck Surgery Division of the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Shahbag, Dhaka from August 2022 to January 2023. 25 patients undergone parathyroidectomy. Parathyroid function was measured as parathyroid hormone (PTH) level. Baseline levels of PTH, and total calcium (Ca) were evaluated preoperatively and their postoperative levels were measured before skin incision, 10 minutes after parathyroidectomy, 24 hours and 7 days accordingly. The data was calculated in an Excel spreadsheet which was then exported to SPSS 26.0 (Statistical Package for the Social Science) for analysis. The statistical significance was set to p<0.05. Results: In this series, 3(8.5%), 6 (17.1%) and 2(5.7%) patients presented with osteitis fibrosacystica, nephrolithiasis and neuropsychiatric syndrome respectively. Moreover, 14 (40.0%) patients had muscle weakness, and 18 (51.0%) subjects presented with fatigue. It was observed that preoperative PTH and calcium levels and postoperative calcium levels in SPHPT and ASPHPT were statistically significant. A notable improvement in health-related quality of life was observed with the VAS score rising from 70 (IQR: 50-80) to 80 (IQR: 70-90). Conclusion: This study provides evidence supporting the enduring advantages of parathyroidectomy in individuals with primary hyperparathyroidism (PHPT). The observed reduction in pre-operative symptoms seems to be a significant factor contributing to the enhanced quality of life (QOL) experienced by these patients over the long term.
- Ahmed Lincoln
- 09 Sep, 2025
Evaluations of the Treatment of Volar Barton Fracture of the Distal Radius by Buttress Plate
Abstract: Background: Distal radius fractures are common, with volar Barton fractures posing a unique challenge due to their intra-articular nature and instability. These injuries often result from high-energy trauma and involve dislocation of the radiocarpal joint. Conservative treatment frequently yields poor outcomes, prompting a shift toward surgical management. Volar buttress plating via open reduction and internal fixation (ORIF) has emerged as the preferred approach, offering stable fixation, early mobilization, and favorable functional recovery. Anatomically contoured low-profile plates enhance outcomes by minimizing soft tissue complications. Despite some risks, such as tendon irritation, clinical results have generally been positive when appropriate surgical protocols are followed. Aim of the study: This study aims to evaluate the treatment outcomes of volar Barton fractures of the distal radius managed with volar buttress plates. Methods: This prospective observational study was conducted over 12 months, from July’23 to June’24 at the Department of Orthopaedics of Pabna Medical College, Bangladesh to evaluate outcomes of volar Barton fractures treated with open reduction and internal fixation using a volar buttress plate. Thirty (30) adult patients with closed, radiologically confirmed Volar Barton fractures were included. The surgery involved a standard volar (Henry’s) approach with fixation using locking or non-locking screws. Postoperative care included early mobilization and radiographic follow-up at 2, 6, and 12 weeks postoperatively. Outcomes were assessed radiologically and functionally using the Mayo Wrist Score. Data were analyzed descriptively using SPSS version 26.0 without inferential statistics. Results: In this study of 30 patients with volar Barton fractures treated using buttress plate fixation, most were males (70%) aged 30–50 years (53.33%), with the right hand predominantly affected (93.33%). The primary cause was falls on an outstretched hand (56.67%). Radiographic union occurred within 6–12 weeks in 70% of cases, and final alignment was maintained in 90% of cases. Functional assessment using the Mayo Wrist Score showed excellent to good outcomes in 86.67% of patients. Complications were minimal, including superficial infection (3.33%), tendon irritation (3.33%), and implant prominence (6.67%). No cases of deep infection, implant failure, or reduction loss were reported. Conclusion: Volar buttress plate fixation is an effective treatment for volar Barton fractures, promoting early union, stable anatomical reduction, and good functional recovery with minimal complications. Optimal outcomes depend on selecting the appropriate patients, performing surgery promptly, and employing precise surgical techniques.
- Ahmed Lincoln
- 09 Sep, 2025
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