International Journal of Research in Medical Sciences
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Hesperidin in dentistry: a natural flavonoid with promising therapeutic potential: a narrative review
Get PDFHesperidin, a flavonoid primarily found in citrus fruits has garnered attention in biomedical research for its potential to inhibit demineralization, enhance remineralization, antimicrobial properties, anti-inflammatory effects, regenerative properties and wound healing. Flavonoids also possess collagen-crosslinking effects and dentin collagen proteolytic degradation inhibition property. Hesperetin (HS), a metabolite of hesperidin, is a polyphenolic component of citrus fruits. This ingredient has a potential role in bone strength and the osteogenic differentiation. This review aims to summarize current evidence regarding the application of hesperidin in various dental disciplines, highlighting its mechanisms of action, clinical relevance and future research prospects. More researches and studies are required in this regard to use them in our daily clinical practices.
Association of coronary calcium arc on stent expansion in patients with non-ST elevation myocardial infarction by intravascular ultrasound
Get PDFBackground: Coronary calcification indicates atherosclerotic plaque burden and contributes to stent under-expansion, leading to complications like restenosis and thrombosis. The impact of coronary calcium severity on stent expansion in NSTEMI patients remains unexplored in our population. This study aimed to evaluate the association between the coronary calcium arc and stent expansion in patients with non-ST elevation myocardial infarction (NSTEMI) using intravascular ultrasound (IVUS).
Methods: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2019 to April 2020. A total of 109 NSTEMI patients undergoing IVUS-guided PCI for calcified lesions at NICVD were enrolled. Based on the calcium arc, 73 patients (0-180°) formed Group I, and 36 (181-270°) formed Group II. Stent expansion was measured. Ethical approval was obtained, and data were analyzed using SPSS version 23.0.
Results: In this study, despite higher balloon pressures in Group II, acute diameter gain (1.5±0.4 mm vs 1.4±0.3 mm, p<0.03), acute CSA gain (5.8±1.2 vs 5.3±1.0, p<0.04), stent expansion by MLD (95.6±2.9% vs 89.6±3.3%, p<0.001), and MLA (92.7±5.1% vs 81.3±6.4%, p<0.001) were lower than in Group I. Stent expansion correlated negatively with calcium arc (MLD: r=-0.66, p<0.001; MLA: r=-0.69, p<0.001) but not with calcium length (MLD: r=0.14, p=0.1; MLA: r=0.09, p=0.36).
Conclusion: Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers
Comparison of oral midazolam versus oral dexmedetomidine for ease of induction and prevention of emergence delirium in pediatric ENT surgeries under sevoflurane anesthesia: a randomized controlled study
Get PDFBackground: Emergence delirium (ED) is a common and distressing complication in pediatric patients following sevoflurane anesthesia. Preoperative anxiety, rapid anaesthetic emergence and postoperative pain contribute to ED. Midazolam is widely used for premedication but has variable efficacy in preventing ED. Dexmedetomidine, a selective alpha-2 agonist, offers sedative and analgesic properties with minimal respiratory depression. This study compared the efficacy of oral midazolam versus oral dexmedetomidine for ease of induction and prevention of ED in children undergoing ENT surgeries under sevoflurane anesthesia.
Methods: In this prospective, randomized, single-blinded trial, 100 children aged 2–12 years (ASA I–II) scheduled for elective ENT surgeries were assigned to receive either oral midazolam 0.5 mg/kg (Group M) or oral dexmedetomidine 2 µg/kg (Group D) 45 minutes before induction. Preoperative sedation, ease of parental separation, mask acceptance, hemodynamic stability, incidence of ED (assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale) and recovery profiles were recorded.
Results: Baseline demographics were comparable between groups. Group D demonstrated significantly better preoperative sedation (RSS 3.6 vs 2.8, p<0.001), easier parental separation (90% vs 74%, p=0.03) and superior mask acceptance (88% vs 70%, p=0.02). The incidence of ED was significantly lower in Group D (8%) compared to Group M (26%, p=0.01). PACU discharge was earlier in Group D (36.5 vs 42.8 minutes, p=0.04). Hemodynamic parameters remained stable in both groups without significant adverse events.
Conclusions: Oral dexmedetomidine provides superior preoperative sedation, smoother induction and significantly reduces emergence delirium compared to oral midazolam in children undergoing ENT surgeries under sevoflurane anesthesia. Dexmedetomidine may be considered a preferred premedication option in pediatric anesthesia practice
The rise of multi-drug resistant Klebsiella pneumoniae in endogenous panophthalmitis: a rare case report
Get PDFEndogenous panophthalmitis is a devastating intraocular infection resulting from hematogenous spread of pathogens, often associated with significant morbidity and mortality. We report a case of fulminant panophthalmitis with orbital cellulitis secondary to carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteraemia in a 71-year-old female with uncontrolled diabetes, chronic kidney disease on haemodialysis, and a recent catheter-related bloodstream infection (CRBSI). The patient presented with severe ocular pain, proptosis, corneal melt, and systemic instability. Imaging revealed vitreous exudates, retinal detachment, and orbital involvement. Blood cultures confirmed CRKP, sensitive only to polymyxin and tigecycline. Aggressive systemic antibiotics and supportive care was initiated, but surgical intervention was deferred due to hemodynamic instability. The patient succumbed shortly due to multiorgan failure. This case underscores the rapid progression of endogenous panophthalmitis in immunocompromised hosts, particularly with multidrug-resistant organisms. Our case highlights the critical need for multidisciplinary management, and prompt source control in catheter-dependent patients. The fatal outcome emphasizes the poor prognosis associated with resistant pathogens, reinforcing the importance of preventive strategies in high-risk populations
Diagnostic accuracy of rapid immunochromatographic test compared to ELISA in dengue fever
Get PDFBackground: Dengue fever is a significant mosquito-borne viral disease affecting tropical and subtropical regions. Early and accurate diagnosis is vital for patient care and outbreak control. While enzyme-linked immunosorbent assay (ELISA) is considered the reference standard for dengue diagnosis, rapid immunochromatographic tests (ICTs) offer quicker, simpler alternatives suitable for point-of-care settings.
Methods: This cross-sectional study evaluated 429 clinically suspected dengue cases from July 2022 to June 2024. Serum samples were tested for NS1 antigen, IgM, and IgG antibodies using both rapid ICTs and ELISA. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ELISA as the gold standard.
Results: The sensitivity of ICTs for NS1 antigen, IgM, and IgG antibodies was 70.97%, 67.14%, and 68.18%, respectively. The corresponding specificities were 99.50%, 99.44%, and 99.51%. PPVs exceeded 97% for all markers, while NPVs ranged from 89.88% to 90.96%.
Conclusions: Rapid ICTs demonstrate high specificity but moderate sensitivity, supporting their use as initial screening tools. ELISA remains essential for confirmatory diagnosis, especially in cases of strong clinical suspicion
Prevalence and clinical patterns of epilepsy in children with spastic cerebral palsy: a cross-sectional study in South India
Get PDFBackground: Cerebral palsy (CP) is frequently accompanied by epilepsy, a comorbidity that exacerbates motor and cognitive impairment. Among the CP subtypes, spastic CP exhibited the highest association with seizures. However, the prevalence and clinical patterns of epilepsy in these children, particularly in the Indian context, remain under-characterized. Objective was to determine the prevalence and characterize the clinical patterns of epilepsy among children with spastic CP in a tertiary care setting in South India.
Methods: This cross-sectional study was conducted over 18 months in the pediatric department of a tertiary hospital. A total of 218 children aged 2-14 years with spastic CP were recruited. Epilepsy diagnosis and seizure types were confirmed using ILAE criteria through clinical history and caregiver interviews. Gross motor function was assessed using the gross motor function classification system (GMFCS). Statistical associations were evaluated using chi-square tests and odds ratios (OR) with 95% confidence intervals (CI).
Results: Epilepsy was prevalent in 52.2% of the patients. The most common type of seizure was tonic-clonic (31.3%), followed by myoclonic (9.6%) and complex partial seizures (8.7%). Children with quadriplegic (36.5%) and diplegic (35.7%) CP exhibited a higher epilepsy prevalence. Epilepsy was most frequent in GMFCS levels II and III. No significant sex differences were observed.
Conclusions: Epilepsy is common in children with spastic CP, particularly among those with quadriplegia, diplegia, and moderate-to-severe motor impairment. Early neurological surveillance and risk-based screening, especially among patients with GMFCS II-IV, may improve detection and long-term outcomes
Use of dupilumab as adjuvant therapy in patients with previous sinus surgery for uncontrolled chronic rhinosinusitis with nasal polyps: a systematic review
Get PDFChronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nose and sinuses where most patients undergo surgery, however, postoperative recurrence of nasal polyps is common resulting in multiple re-interventions. Biological therapies such as dupilumab have been developed to suppress the inflammatory pathways involved in this disease. The aim of the present review is to evaluate the impact of the use of dupilumab in patients with uncontrolled CRSwNP, and its effect on the frequency of revision surgeries. A bibliographic search was performed in PubMed, Cochrane and Google Scholar. included articles published between 2019 and 2024, meta-analyses, systematic reviews, randomized controlled trials, studies in adult population, and the use of dupilumab in patients with previous sinus surgery. The quality of evidence was assessed using GRADE. Seven studies were included, totaling 1603 patients with uncontrolled CRSwNP, 84.6% of the total patients had a history of having undergone at least one surgery, after completion of follow-up, dupilumab demonstrated a reduction in the frequency of revision surgeries in addition to an improvement in sinonasal symptoms. Existing evidence supports the benefit of the use of dupilumab as an adjuvant therapy in patients with uncontrolled CRSwNP due to the reduction in the frequency of revision surgeries. Further studies addressing the effect of dupilumab in the short-term postoperative period are needed to compare the results obtained
Emphysematous osteomyelitis with acute promyelocytic leukemia: a rare case report
Get PDFEmphysematous osteomyelitis represents an infrequent clinical entity. The confluence of acute promyelocytic leukemia (APML), immunosuppression, and an elevated susceptibility to opportunistic infections—exacerbated by bacteraemia-may precipitate the pathogenesis of this gas-forming osteomyelitis process. A 63-year elder male presented to our hospital with consistent fever and chills from past one month. Hematological evaluation revealed pancytopenia. Subsequent bone marrow aspiration and flow cytometry confirmed a diagnosis of acute myeloid leukemia (AML), further substantiated by reverse transcriptase-PCR demonstrating a PML/RARA bcr-3 fusion transcript, confirming the diagnosis of acute promyelocytic leukemia (APML). The patient received a contemporary chemotherapy that included all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), leading to a notable enhancement in the results. However, during treatment, he developed bacteraemia with Klebsiella pneumoniae, confirmed via blood and urine cultures. A high-resolution computed tomography (CT) scan unveiled the pathognomonic presence of intraosseous gas, confirming emphysematous osteomyelitis. Selected intravenous antibiotic therapy yielded in marked clinical amelioration, thus obviating the requirement for surgical debridement. This case underscores the imperative role of advanced imaging modalities in detecting rare infectious sequelae and demonstrates that, with prompt recognition and appropriate antimicrobial intervention, conservative management can yield favorable outcomes even in severely immunosuppressed hosts
Outcomes of microsurgical flap techniques in the reconstruction of extensive lesions due to advanced basal cell carcinoma: a systematic review of complications, recurrence, and aesthetic satisfaction
Get PDFBasal cell carcinoma (BCC) constitutes 70–80% of non-melanoma skin cancers, with an estimated 4.3 million new cases annually in the U.S. Though rarely metastatic, advanced BCC can cause extensive local tissue destruction, particularly in facial regions, necessitating surgical excision followed by complex reconstruction. This study evaluates outcomes of microsurgical flap reconstruction in advanced BCC, with a focus on complications, recurrence, and patient-reported aesthetic satisfaction. A systematic search across six databases until May 2025 identified 263 abstracts, of which 34 full texts were reviewed; nine studies met inclusion criteria. Due to methodological heterogeneity, a narrative synthesis was conducted. Most studies reported low complication rates, with serious issues occurring in fewer than 10% of cases and no significant differences across flap types or age groups. Recurrence rates ranged from 0.22% to 4.4%; notably, 447 lesions treated with narrow margins and frozen section analysis showed a recurrence of only 0.22%. A meta-analysis reported an overall recurrence rate of 2%, with the Muffin technique associated with superior outcomes. Aesthetic results were favorable: OM flaps yielded high satisfaction rates (77.8%, p=0.002) with shorter operative times, and periocular reconstructions demonstrated successful outcomes in 87% of cases, outperforming radiotherapy (69%). However, definitions of "satisfactory" varied across studies. Despite limitations such as inconsistent outcome reporting and short follow-up durations, microsurgical reconstruction in advanced BCC appears safe, effective, and cosmetically satisfactory. OM flaps, in particular, are seen as efficient by both clinicians and patients. Standardized, long-term studies are essential for definitive conclusions
Diagnostic concordance of ultrasound and histopathology in pediatric neck masses
Get PDFBackground: Ultrasonography has become the most accessible, safe, and cost-effective imaging modality for evaluating pediatric neck masses, especially in resource-limited settings. The purpose of the study was to assess the diagnostic concordance between ultrasound findings and histopathological results in pediatric neck masses. The aim of the study was to evaluate the diagnostic concordance between ultrasound findings and histopathological results in pediatric neck masses.
Methods: This observational diagnostic study was conducted at Bangladesh Shishu hospital and institute from October 2023 to March 2025, involving 550 children (0-12 years) with palpable neck masses. All cases underwent ultrasound and confirmatory histopathological examination. Diagnoses were made independently by radiologists and blinded pathologists. Concordance was defined as an exact diagnostic match. Data were analyzed using SPSS v28 with descriptive statistics.
Results: Among 550 pediatric patients with neck masses, most were aged >2-5 years (50.9%) with a balanced gender distribution. Lymphadenitis was the most common ultrasound (40.6%) and histopathological (34.2%) finding. Congenital lesions like cystic hygromas, thyroglossal duct cysts, and haemangiomas were also frequent. Ultrasound showed high diagnostic concordance, particularly for cystic hygromas (98.0%), thyroglossal duct cysts (97.7%), and branchial cleft cysts (96.2%), with an overall concordance rate of 90.0%.
Conclusions: Ultrasound demonstrates high concordance with histopathology, reinforcing its value as a reliable, non-invasive first-line diagnostic tool for pediatric neck masses