Introduction: Total knee arthroplasty (TKA) is a highly successful procedure that can reduce pain and improve range of motion and function by correcting angular deformity and restoring the integrity of the articular surface. Currently, joint replacement for various types of knee arthritis is very common, and TKA can claim to be one of the greatest surgical advances. Objective: To determining about the suitability of implants available for Bangladeshi population by assessing the intra op measurement of patella in all its dimensions viz anteroposterior, superioinferior and mediolateral diameter in Bangladeshi patients. Methods: A cross-sectional study was carried out at Department of Orthopaedic Surgery, BSMMU, Dhaka, Bangladesh from January to June 2023. Total 60 patients of grade 4 OA knee were selected for this study and pre op x-rays were obtained, AP View, Lat View, Skyline view and Merchant view. Preop Morphometry of patella was recorded on x-ray findings. All patients were operated by standard midline incision with medial parapatellar arthrotomy. Intra op measurement of patella was done via Vernier caliper and measurements were recorded. Results:Total 60 patients of grade 4 OA knee were selected for this study. The smallest available patellar implant in Bangladesh is about 8 mm in size which is not suitable for Bangladeshi patient. most of the patients were having patellar morphometery lower than the expected size for patellar resurfacement. Hence, patellar resurfacement was not an option for many of the patients because of unavailability of patellar implants of appropriate size. Conclusion: Hence in this study we conclude that there is a need of better designed implants for Bangladeshi patients as the presently available implants are mainly designed for western population making it unfeasible to resurface patella for Bangladeshi surgeons.

Abstract: Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by irregular ovulation and the presence of small cysts on the ovaries. This condition is frequently associated with obesity, insulin resistance, and diabetes. Aim: This research aims to investigate the effects of Moringa oleifera leaves extract on HbA1c levels in white rats (Rattus norvegicus) that have been induced to model insulin-resistant PCOS. Moringa oleifera has various bioactive compounds such as flavonoids, that function as insulin sensitizers, which help improve glucose uptake. Method: This research employs a laboratory experimental design using female rats as subjects. The rats were divided into three groups (n=10): normal rats, PCOS-IR rats (received an intraperitoneal injection of testosterone at a dose of 1 mg/100 g BW for 21 days), and PCOS-IR rats with Moringa oleifera (received the same testosterone injection for 21 days followed by an administration of 500mg/kg Moringa oleiferaleaves extract for an additional 21 days).Blood samples are subsequently collected and analyzed for HbA1c, and the gathered data will undergo statistical processing. Results: The PCOS-IR group exhibited higher HbA1c levels than the negative control group, while the group treated with Moringa oleifera demonstrated significantly lower HbA1c levels than the PCOSIR group. The HbA1c levels in the Moringa oleifera treated group approached those of the control group. Conclusion: This research indicates that the 96% ethanol extract of moringa leaves may provide an effective alternative treatment for managing metabolic issues associated with PCOS-IR, particularly in relation to HbA1c levels.

Introduction: Pancytopenia is the reduction of all three cellular elements of peripheral blood, leading to anemia, leukopenia and thrombocytopenia, and clinico-hematological entity commonly encountered in clinical practice as a feature of a myriad of diseases, ranging from non-malignant disease to malignant neoplasms. Material and Methods: In our study, a total of 100 cases of pancytopenia were included. Complete evaluation of clinical findings, haematological indices and bone marrow examination were carried out. Results: In our study the most common cause of pancytopenia was megaloblastic anemia (44%), followed by dimorphic anemia or nutritional anemia (32%) and less commonly observed causes were acute leukemia and iron deficiency anemia. Most common anemia found to be macrocytic hypochromic. Hypercellular marrow was seen in 64% of cases, whereas hypocellular marrow was present in 8% of cases. Conclusion: Bone marrow aspiration and haematological parameters are useful, economical, and safe diagnostic tool in the evaluation of pancytopenia.

Background: Maternal thyroid disorders during pregnancy can significantly impact fetal development and increase the risk of adverse pregnancy outcomes, including miscarriage, preterm birth, low birth weight, and neonatal morbidity and mortality. This study aims to evaluate the prevalence of thyroid dysfunction in a cohort of 300 neonates (aged 1-28 days) at a tertiary care centre, with a focus on comparing the thyroid hormone levels between neonates born to mothers with and without thyroid disorders. Methods: This was a prospective, observational study conducted over a 12- month period. The neonates were further divided into two groups based on maternal thyroid status: (i) cases (N=150) and (ii) controls (n=150). In the first and third postnatal weeks, the study group's infants' thyroid tests were measured. Results: The mean TSH levels were significantly higher in neonates of mothers with thyroid disorders, while the mean free T4 level was significantly lower in this group. The prevalence of subclinical hypothyroidism (elevated TSH with normal free T4) was significantly higher. Conclusions: Early identification and management of thyroid disorders in newborns can help prevent the adverse effects on growth and neurodevelopment.

Background: Few studies which have reported very low incidence of DVT in India have been conducted in patients undergoing elective orthopaedic surgery and used colour duplex for diagnosis.Despite having fewer comorbid conditions, orthopaedic patients with deep vein thrombosis remain particularly vulnerable to calf deep vein thrombosis. Rates of venous thromboembolism prophylaxis were inadequate. With the aforementioned facts, the need of this study is to establish evidence of deep vein thrombosis in patients with lower limb trauma as early as possible, adequately manage it and prevent its complications Methods: Total of 83 patients admitted in Orthopaedics department with lower limb fractures satisfying the inclusion criteria and exclusion were included in the study. Thorough history and clinical examination data were obtained, venous doppler ultrasound studies were done clinical scoring for risk of deep vein thrombosis was done using Well’s criteria and noted. Post operatively on day 4, another colour venous doppler study of the lower limbs was be performed and clinical scoring for risk of deep vein thrombosis was be done using Well’s criteria and noted. For patients who developed symptoms/signs of deep vein thrombosis during their stay at the hospital, appropriate chemoprophylaxis was started for these patients who developed deep vein thrombosis, follow up colour venous doppler study of the lower limbs was done after 3 months to look for re-canalization of the affected venous system Results: In our study among 83 subjects, 48.2 % are from 20 to 40 years of old. Male subjects constituted 68.7%. There were no associated comorbidities among 81.9%(n=68) of study subjects. Pertrochanteric fracture constituted common fracture. Majority had closed type of fractures. Pre operative Wells score was 1.5 and 3 among 50.6% (n=42) and 47% (n=39) subjects 15 respectively with mean value of 2.386. The mean post operative Well’s score was 2.512 and 61.4% (n=51) and 22.9% (n=19) subjects has Well’s score of 1.5 and 3 respectively. The preoperative doppler showed no evidence of DVT among 97.6% while both fat embolism syndrome and DVT was seen in 1.2% (n=1) subjects. While the post operative doppler showed no evidence of DVT among 98.8%(n=82) subjects. One subject out of 7 with hypertension suffered from DVT. Conclusion: In our study among 83 subjects, 48.2 % are from 20 to 40 years of old. Male subjects constituted 68.7%. There were no associated comorbidities among 81.9%(n=68) of study subjects. Pertrochanteric fracture constituted common fracture. Majority had closed type of fractures. Pre operative Wells score was 1.5 and 3 among 50.6% (n=42) and 47% (n=39) subjects respectively with mean value of 2.386. The mean post operative Well’s score was 2.512 and 61.4% (n=51) and 22.9% (n=19) subjects has Well’s score of 1.5 and 3 respectively. The preoperative doppler showed no evidence of DVT among 97.6% while both fat embolism syndrome and DVT was seen in 1.2% (n=1) subjects. While the post operative doppler showed no evidence of DVT among 98.8%(n=82) subjects. One subject out of 7 with hypertension suffered from DVT.

Objective: The study of correlation between sizes and type of tympanic membrane perforations with degree of hearing loss.Study Design: Cross sectional observational study.Setting: E. N. T OPD, at AGMC & GBP Hospital, Tripura.Materials and Methods: 110 patients (118 ears) of COM (safe type)were selected from Dec 2020 to June 2022. Instruments used for data collection/processing included questionnaires, oto-endoscopy (hand held portable) and microscopy, Pure tone audiometer and image J software.Results: 110 patients (56-males, 54-females), aged 15-60 years (mean age 41.00 years ± 13.99 years) with 118 perforated eardrums were studied. 8(7.3%) had bilateral TM perforations, 53(48.2%) right unilateral and 49(44.5%) left unilateral. The various sizes of perforation and their hearing loss were as follows: Group I (total perforation) no. of ear=3. Group II (subtotal perforation) no. of ear=19. Group III (central perforation) no. of ear = 96. Based on size of perforation GROUP 1 (40mm sq.) 18 examined ears.Amongst the central perforation 19 ears had HL < 35db and 73 ears have mean hearing loss 35 - 55 db and 4ears have HL >55db. Amongst the subtotal perforation11 ears have mean hearing loss 35-55db & 8 ears have HL >55db. Amongst the total perforation 1 ear have HL 35-55db and 2 ears have mean hearing loss > 55db and Difference was significant, P value<0.001.Conclusion: A linear relationship existed between sizes and type of tympanic membrane perforation with degree of hearing loss.

Background: Traumatic optic neuropathy (TON) is a potential complication of traumatic brain injury (TBI) in patients with road traffic accidents (RTAs). This study aimed to investigate the correlation between TON and TBI severity and evaluate the fundoscopic changes and visual outcomes in these patients.Methods: A cross-sectional study was conducted on 30 patients with TON following RTAs. The type of TON (direct or indirect) was assessed, and the severity of TBI was categorized based on the Glasgow Coma Scale (GCS) score. Fundoscopic changes and visual acuity were evaluated and compared between TON types and TBI severity groups.Results: Indirect TON was more common (63.3%) than direct TON (36.7%). Direct TON was significantly associated with severe TBI (75.0%), while indirect TON was more prevalent in mild (77.8%) and moderate (76.9%) TBI (p=0.041). Optic disc edema was more frequent in direct TON (72.7%) than in indirect TON (31.6%) (p=0.027). Visual acuity was significantly worse in direct TON compared to indirect TON (p=0.027). Conclusion: The type of TON is significantly associated with the severity of TBI in patients with RTAs. Direct TON is more common in severe TBI and is associated with worse visual acuity and a higher prevalence of optic disc edema compared to indirect TON. Comprehensive ophthalmic evaluation is crucial in patients with TON and TBI to ensure early diagnosis and appropriate management.

Background:Migraine is a primary neurovascular headache disorder characterize by moderate to severe headaches, most often unilateral and generally associated with nausea and increased sensitivity to light and sound. Several factors can trigger migraine are probable contributing factors while others are possible or unproven such as:stress, hormonal changes, skipped meal, smoking, odour etc.Propranolol (non selective beta blocker) is the most common and one of the most effective first line medication used for migraine prophylaxis. Flunarizine (Calcium channel blocker) is acknowledged in numerous countries and included in numerous national guidelines for prophylaxis of migraine.We therefore intended to carry out this study and produce more data to support the choice of a medication for migraine prophylaxis that is both more effective and has a better safety profile.Aim: The aim of our study was to compare safety and efficacy of propranolol with flunarizine in adult patients suffering from migraine as prophylactic drugs. Objectives: 1) To evaluate safety and efficacy of propranolol.2) To evaluate safety and efficacy of flunarizine. Material and Methods: This comparative, prospective, randomized, and academic interventional study was conducted in tertiary care hospital of North India. A total of 76 patients satisfying the eligibility criteria were randomized into 2 groups to receive either the Tablet Propranolol 40 mg per day for first 5 days then 40 mg twice a day for 2 months or Tablet Flunarizine 10 mg per day for 2 months. A general evaluation, physical examination and routine investigations were performed on the first visit and repeated after every one month of treatment for next 2 months. Patient also assessed with VAS (Visual Analogue Scale) for headache intensity 1 (mild) to 10 (excruciating), to check extent of a patient’s disease. Results:Group A (89.2%) and Group B (52.8%) patients were in age group of 18-40 years. In Group A, dizziness (n = 20) was the most common adverse effect associated with propranolol, while in Group B; tiredness (n = 3) and weight gain (n = 3) were the most common adverse effects associated with flunarizine. There was statistically significant increase in BMI after 2 months among patients who were in Group B than those who were in Group A (p=0.045). There was statistically significant difference in the mean (SD) Heart Rate value of participants in Group A (75.65± 5.1) and Group B (80.14 ± 5.9) at the end of 2nd month (p=0.001).Also, there was statistically significant improvement in headache frequency (p=0.01) headache intensity (p=0.004) and headache duration (p=0.04) in Group A as compare to Group B. Conclusion: Flunarizine was associated with fewer adverse effects and Propranolol was associated with low headache frequency, headache intensity and headache duration as compared to flunarizine group. Trial Registration: Clinical Trials Registry – India (CTRI) Number CTRI/2023/06/053593 [Registered on: 06/06/2023].

Plasma cell disorders, including multiple myeloma, are a group of diseases characterized by the abnormal proliferation of plasma cells. While pleural effusion is uncommon in multiple myeloma, it may result from myelomatous infiltration of the pleura or heart failure due to amyloidosis. In this report, we present a case of a 62-yearold male who was diagnosed with multiple myeloma after presenting with progressive dyspnea, cough, and generalized weakness over two months. Physical examination revealed diminished breath sounds over the left hemithorax. Chest X-ray and ultrasonography confirmed moderate pleural effusion, with 1000 mL of serosanguinous fluid aspirated. Pleural fluid analysis showed lymphocytic exudative effusion, elevated adenosine deaminase (76 IU/L), and plasma cell dyscrasias, indicative of multiple myeloma. Blood tests revealed anemia (Hb 7.5 g/dL) and renal impairment (serum creatinine 2.4 mg/dL). Imaging studies identified multiple lytic lesions in the skull and compression fractures in the thoraco-lumbar spine. Bone marrow aspirate showed 46% plasma cells. The patient was diagnosed with multiple myeloma and initiated on chemotherapy, showing clinical improvement with no recurrence of pleural effusion on follow-up. This case emphasizes the rarity of myelomatous pleural effusion and highlights the importance of early diagnosis and appropriate management. Treatment typically involves chemotherapy, with supportive care to manage symptoms, though the prognosis remains poor in cases of myelomatous pleural effusion.

Background: Preterm premature rupture of membranes (PPROM) significantly impacts maternal and perinatal outcomes. This study evaluated outcomes and predictive factors in PPROM cases.Methods: A prospective observational study of 80 women with PPROM between 24 and 36 weeks' gestation was conducted. Maternal and neonatal outcomes were analyzed, and factors affecting latency period were evaluated.Results: The mean gestational age at PPROM was 31.3 ± 3.4 weeks, with a mean latency period of 8.4 ± 4.2 days. Chorioamnionitis occurred in 17.5% of cases. The cesarean section rate was 42.5%, with fetal distress being the primary indication (44.1%). NICU admission was required for 60.0% of neonates, with respiratory distress syndrome affecting 35.0%. Significant correlations were found between latency period and gestational age (r=-0.542, p<0.001), cervical dilatation (r=-0.486, p<0.001), and inflammatory markers (p<0.01). Conclusion: PPROM outcomes are significantly influenced by gestational age and inflammatory markers. Early identification of risk factors may improve management strategies and outcomes.