Medical Science: Updates and Prospects Vol. 7

Diagnostic Accuracy of Barium Enema in Colorectal Cancer: A Histopathological Correlation Study

Md. Abdul Gafur — Sat, 14 Mar 2026 00:00:00 +0000

Background: Colorectal cancer is a disorder that occurs exclusively in the colon or rectum and is caused by the colon’s aberrant proliferation of glandular epithelial cells. Two commonly used strategies for initial evaluation are Double Contrast Barium Enema (DCBE) and diagnostic lower GI endoscopy. Barium enema is easy to perform, does not require sedation, is inexpensive, and is readily available in Bangladesh. However, limited data are available on its diagnostic accuracy in the local population.

Aim of the Study: This study aims to determine the diagnostic value of barium enema in colorectal cancer.

Materials and Methods: A prospective study was carried out on 50 cases presented with clinical features of colorectal cancer in Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and National Institute of Cancer Research & Hospital (NICRH) during the period July 2000 to June 2001. Of the 50 patients, 30 were male, and 20 were female. The mean age of the male patients was 46 ± 10.8 years, while that of the female patients was 44.5 ± 11.2 years. All 50 cases underwent barium enema examination under fluoroscopic control; single-contrast studies were performed in 11 cases, and double-contrast studies were performed in 39 cases. The findings of barium enema examination were confirmed by histologic examination of the specimens obtained by colonoscopy, and in 10 cases, after operation. Moreover, questionnaires, interviews, case history and clinical examinations were conducted to collect all the relevant data and analysed statistically.

Results: No statistically significant difference was found between the age and sex of the patients. In Western countries, colorectal cancer typically occurs in late adulthood, most commonly in the sixth and seventh decades of life; however, in this study, the highest incidence was observed in the fourth and fifth decades, followed by the sixth decade. Males predominate over females, and the rectum is more involved than the colon. It was found that 96% of patients took meat and fat, and one patient had a family history of colon cancer. Colorectal cancer was more common (44%) in better socio-economic conditions than in low (4%). Constipation (70%) and per rectal bleeding (64%) were predominant symptoms, and 68% cases had abnormality in per rectal examination. Out of 40 cases, colonoscopy detected a lesion in 33 cases, one was a false positive, and 7 cases were negative; of them, 3 cases were false negatives, and 4 were true negatives. In 50 cases, barium enema detected a lesion in 42 cases; 2 were false positives. 8 cases were negative in barium enema, of them 5 were false negatives, and 3 were true negatives. Histologically, 45 (90%) cases proved to be adenocarcinoma, among them 4 (8%) cases were mucinous adenocarcinoma. Five cases were histologically negative. The sensitivity and accuracy of barium enema were 88.9% and 86%, and those of colonoscopy were 91.4% and 90%, respectively.

Conclusion: Though colonoscopy has greater sensitivity and accuracy, it is less acceptable to the patients, has a high cost, is not easily available, requires sedation and expertise and the entire colon is not seen in 2-40% of patients. The study concluded that barium enema may be considered a suitable initial investigation for the diagnosis of clinically suspected colorectal cancer. However, as this was a single-centre study with a small sample size, future research should include larger sample sizes and multicenter studies to validate these findings.

Current Progress in Remineralisation Therapies for Dental Caries: A Review

Sihivahanan Dhanasekaran, Vijay Venkatesh Kondas — Sat, 14 Mar 2026 00:00:00 +0000

The oral illness known as dental caries is a prevalent and complicated condition that has been a source of considerable health care issues for communities for quite some time. A number of different remineralising agents provide assistance to the remineralisation process, which helps to prevent the progression of illness and improve the shape and functionality of the teeth. Remineralisation is the process of adding important minerals, primarily phosphate and calcium, and integrating them into areas of dental decay that have lost these minerals as a result of demineralisation of tooth structure. This process is known as remineralisation. The current chapter discusses numerous materials that facilitate and encourage the remineralisation of tooth structure, along with their deployment in clinical practice. Research has primarily concentrated on creating resin-based composite formulations, with less attention paid to the development of dental adhesives, crown cements and resin-based sealants. Future research should prioritise the comprehensive evaluation and characterisation of these materials to better understand their mechanical and antibacterial properties.

Medical Sciences Marketing: Challenges and Benefits

Sat, 14 Mar 2026 00:00:00 +0000

Healthcare is a constantly evolving field, offering a plethora of opportunities that stimulate creativity and enthusiasm, while challenging specialists to fully apply their expertise. Marketing plays a crucial role in the field of medical sciences, enabling healthcare organisations to effectively promote their services, engage with patients, and drive positive health outcomes. However, the unique nature of medical sciences poses specific challenges and opportunities for marketing practitioners. This chapter explores the challenges medical sciences marketing faces and the potential benefits it can offer. Through an examination of existing literature and case studies, this chapter aims to shed light on the strategies and approaches that can help healthcare organisations overcome obstacles and leverage marketing to enhance patient care and overall healthcare delivery. This chapter suggests employing strategies such as content marketing, digital marketing, relationship marketing, and collaborative partnerships for healthcare organisations to overcome challenges and harness the power of marketing. Currently, the industry is transitioning from experimental AI to a connected intelligence model, where artificial intelligence acts as an integral operating system for all marketing strategies. Future research should focus on exploring how emerging technologies, particularly artificial intelligence and connected intelligence models, can be effectively integrated into healthcare marketing strategies while maintaining ethical standards and patient trust.

Fine Needle Aspiration Cytology Analysis of Breast Lumps: A Histopathological Correlation Study

S. Akter, M. J. Islam, M. S. Haque — Sat, 14 Mar 2026 00:00:00 +0000

Background: Since the introduction of fine needle aspiration cytology (FNAC), the diagnostic approach to palpable breast lumps has been significantly improved. FNAC is a minimally invasive, rapid, and cost-effective technique with high sensitivity and specificity, and it remains an integral component of triple assessment for breast lesion diagnosis.

Objective: This study aims to analyse the cytological spectrum of palpable breast lumps diagnosed by FNAC and to evaluate its diagnostic accuracy in differentiating benign and malignant breast lesions through histopathological correlation.

Materials and Methods: A two-year prospective study was conducted at our institution, during which 490 FNAC procedures (including six bilateral cases) were performed on patients presenting with palpable breast lumps. Suppurative and inflammatory lesions were excluded. Cytological diagnoses were categorized as benign, suspicious and malignant. Among these cases, 94 patients subsequently underwent mastectomy or open/excision biopsy, and FNAC findings were correlated with histopathological diagnoses. Diagnostic performance parameters of FNAC were calculated using histopathology as the gold standard.

Results: Of the 490 FNAC cases, 373 were reported as benign, 4 as suspicious for carcinoma, and 113 as carcinoma. The majority of patients were premenopausal women, with the most common age group being 31–40 years. Histopathological follow-up was available in 94 cases. FNAC demonstrated an accuracy of 100% for benign lesions and 92.10% for malignant lesions, with a false-negative rate of 7.90% and no false-positive results. The overall sensitivity, specificity, positive predictive value, and negative predictive value of FNAC in diagnosing palpable breast lumps were 92.10%, 100%, 100%, and 94.91%, respectively.

Conclusion: FNAC, when performed by experienced hands, is a highly reliable diagnostic tool for palpable breast lumps, characterised by very high specificity and an extremely low false-positive rate. Its sensitivity can be further enhanced through appropriate clinical and imaging correlation. Despite evolving diagnostic modalities, FNAC continues to play a vital role in the systematic evaluation and management of breast lumps, particularly within a multidisciplinary diagnostic framework.

Skeletal Survey Imaging: From Basics to Future Trends

Hiba Shakeel, Iba Chaudhary, Mohd. Kamil, Mohd. Arfat — Sat, 14 Mar 2026 00:00:00 +0000

Skeletal Survey (SS) imaging is a method by which the diagnosis of suspected non-accidental injury (NAI) and other forms of skeletal dysplasia is achieved, and high Quality Assurance (QA) is essential to high diagnostic yield. The chapter is an informational helpbook on the modern practices of SS, as it addresses the transformation of the traditional radiography model into transformative types of technological development. We present renewed discussion on Dual-Energy CT (DECT) and Photon-Counting Detector CT (PCD-CT) and Artificial Intelligence (AI) fracture-detection models, with a more specific focus on how they aid in improving their diagnostic accuracy and efficiency. Additionally, the chapter discusses how these innovations can be used together with the necessary medico-legal and radiation safety (ALARA) standards. Combining clinical standards and new technology, the given work is supposed to equip clinicians with the means to achieve maximum patient outcomes and the highest standards of musculoskeletal radiology.

Gestational Diabetes Mellitus and Diabetes in Pregnancy as Risk Factors for Preterm Premature Rupture of Membranes

Sat, 14 Mar 2026 00:00:00 +0000

Premature rupture of membranes is the rupture of gestational membranes prior to the onset of labour. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm premature rupture of membrane, which is a significant risk factor for perinatal morbidity and mortality. Gestational diabetes mellitus and diabetes in pregnancy probably increase the risk of premature rupture of membranes or the prevalence of premature rupture of membranes and fetal complications during pregnancy. The objective of this descriptive cross-sectional study was to analyse the frequency of patients with Gestational Diabetes Mellitus (GDM) and Diabetes mellitus in Pregnancy (DIP) among all admitted PPROM patients in the Fetomaternal Medicine unit of Dhaka Medical College Hospital from 01/01/2020 to 31/12/2020. A total of 103 patients with PPROM were included. Among them, 10 (9.7%) participants were suffering from gestational diabetes mellitus and diabetes in pregnancy, 6 (5.8%) were multiple gestation, 7 (6.7%) were associated with preterm labor, 7 (6.79%) patients had gestational hypertension, 4 (3.88%) were with fetal growth restriction, 3 (2.91%) had fetus with congenital anomaly and 2(1.94%) patients were with anaemia. The study found that GDM and DIP were the most common risk factors among PPROM patients in this cohort. As still now there is scarcity of study regarding the identification of risk factors of PPROM; more studies with a large sample size are needed. Larger studies are recommended to further establish the role of GDM and DIP in its pathogenesis. Awareness should be developed among obstetricians towards early detection of GDM and DIP as a preventive method for PPROM from the first trimester of pregnancy.

Comparative Performance of Sepsis Scoring Systems: An Indian Clinical Perspective

Sat, 14 Mar 2026 00:00:00 +0000

Background: Sepsis continues to impose a major healthcare burden globally. Early identification and prompt initiation of appropriate therapy, particularly antibiotics, are critical determinants of survival. Various bedside scoring systems have been developed for early detection and prognostication of sepsis.

Objective: This chapter compares the predictive accuracy of Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), and Modified Early Warning Score (MEWS) for in-hospital mortality among patients with suspected sepsis admitted to the intensive care unit (ICU).

Methods: This prospective comparative study was conducted in the Department of General Medicine and Critical Care at Dhiraj General Hospital, affiliated with Sumandeep Vidyapeeth University, Waghodia, Gujarat, India. A total of 188 adult patients with suspected sepsis admitted to the ICU were included. Clinical and laboratory parameters required to calculate SIRS, qSOFA, NEWS, and MEWS were recorded at admission. The Modified EWS (MEWS) score comprises five physiologic variables: systolic blood pressure (SBP), HR, RR, temperature, and mental status. The MEWS score considers the relative deviation from a patient’s normal blood pressure and urine output to identify surgical patients who would potentially benefit from intensive care. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC) were calculated for each scoring system in predicting ICU mortality. Hierarchical Summary Receiver Operating Characteristic (HSROC) curve analysis was performed to compare overall prognostic accuracy.

Results: Among 188 patients, 42 (22.34%) died during hospitalisation. qSOFA ≥2 demonstrated the highest specificity (73.61%) but the lowest sensitivity (36.02%). SIRS ≥2 and NEWS ≥5 showed the highest sensitivity (77.78%), although SIRS had the lowest specificity (23.88%). MEWS ≥5 demonstrated balanced performance with a sensitivity of 76.36% and specificity of 63.91%. The highest discriminatory ability for ICU mortality was observed with MEWS ≥5 (AUROC 0.76; 95% CI 0.68–0.84), compared to NEWS ≥5 (AUROC 0.61), qSOFA ≥2 (AUROC 0.56), and SIRS ≥2 (AUROC 0.49). HSROC analysis confirmed the superior overall prognostic performance of MEWS. The better predictive accuracy of NEWS is most likely due to the fact that it incorporates a larger number of physiological parameters than qSOFA and SIRS, including the majority of their constituent atoms. Any scoring system for sepsis should favour better sensitivity over specificity because the consequences of false-negative results (delayed or missed therapy) are arguably much higher than those of false-positive results (unnecessary antibiotics). The AUROC for SIRS, however, was so low that it appears to have very little clinical use.

Conclusion: Among the four scoring systems evaluated, MEWS demonstrated the highest predictive accuracy for ICU mortality. However, none of the scoring systems achieved both high sensitivity and high specificity. These tools should therefore complement, rather than replace, comprehensive clinical assessment.

Concurrent Severe Rheumatic Carditis and Idiopathic Nephrotic Syndrome in a Child: A Rare Case Report

Sat, 14 Mar 2026 00:00:00 +0000

Background: Rheumatic carditis is a severe immune-mediated complication of group A beta-hemolytic streptococcal infection, while idiopathic nephrotic syndrome is the most common glomerular disease in childhood. The coexistence of rheumatic carditis and renal disease suggests a shared immunopathogenic mechanism related to streptococcal infection. However, the simultaneous occurrence of rheumatic carditis and idiopathic nephrotic syndrome in the same patient is exceptionally rare, with very few cases reported in the literature.

Aim: The study aims to present the case of a 5-year-old child presenting with severe rheumatic carditis associated with idiopathic nephrotic syndrome, highlighting the diagnostic challenges, therapeutic management, and possible immunological links between these two conditions.

Case Presentation: This chapter presents the case of a 5-year-old boy admitted for generalised oedema and respiratory distress following a recent episode of tonsillitis. Clinical evaluation and investigations revealed severe decompensated rheumatic carditis associated with idiopathic nephrotic syndrome. Echocardiography showed dilation of all four cardiac chambers, biventricular systolic dysfunction, and multiple valvular regurgitations. Laboratory findings revealed nephrotic-range proteinuria and hypoalbuminemia, with elevated antistreptolysin O titers. The patient was treated with systemic corticosteroids, diuretics, an angiotensin-converting enzyme inhibitor, and antibiotic therapy, including secondary prophylaxis with benzathine penicillin. The clinical course was favourable, with rapid resolution of oedema, improvement in respiratory symptoms, normalisation of cardiac findings, and complete disappearance of proteinuria within one month of treatment.

Conclusion: This case describes the first documented association of severe rheumatic carditis and idiopathic nephrotic syndrome in a pediatric patient. It highlights the potential for multisystem immune-mediated complications following streptococcal infection and underscores the importance of early recognition and appropriate management in pediatric patients. Owing to the single-case design, causal inferences and definitive conclusions regarding shared immunopathogenic mechanisms remain limited. Further investigations are warranted to clarify the mechanisms that may account for the coexistence of these two conditions.

Predominance of Upper Gastrointestinal Endoscopy for Dysphagia and Esophageal Disease: A 5-Year Analysis at a Private Hospital in Western Kenya (2020–2024)

Raymond Oigara, Roselyne Nyakona David, Samuel Mong’are — Sat, 14 Mar 2026 00:00:00 +0000

Background: Gastrointestinal endoscopy is essential for diagnosing upper and lower GI disorders in resource-limited settings, where upper GI conditions predominate but lower GI screening remains underutilised. Esophagogastroduodenoscopy (EGD) is a diagnostic procedure carried out to visualise the mucosal lining of the oesophagus, stomach, and proximal duodenum.

Objective: This retrospective descriptive study evaluated diagnostic data from 5,544 patients who underwent esophagogastroduodenoscopy (EGD) and colonoscopy between March 2020 and March 2024 at a private hospital in Kisii County, Kenya. The study aimed to evaluate the use of procedures, patient profiles, clinical reasons, and diagnostic outcomes to inform practice and planning for healthcare and resources.

Methods: Data extracted were patient age, gender, pre-medication, reasons for endoscopy, results, provisional diagnoses, and clinical impressions. Data were analysed using SPSS version 25.

Results: Results demonstrated a very strong predominance of EGD procedures (98.8%) over colonoscopy (1.2%), reflective of a very strong imbalance between access and utilisation. The extreme disparity suggests potential underuse of colonoscopy, most likely attributable to limited equipment, specialist access, and referral patterns. Dysphagia was the most frequent clinical indication for EGD, in excess of 43% of cases, with malignancy and peptic ulcers representing a substantial disease burden. Referral indications were highly aligned with diagnostic results, reflective of the clinical importance of current referral patterns. The gender ratio was approximately equal, and the 41–80 years age category was found to be a priority group for interventions.

Conclusion: The findings highlight the need to strengthen diagnostic capacity for dysphagia and oesophageal diseases, optimise protocols for upper gastrointestinal bleeding and hematemesis, promote early evaluation and management of functional dyspepsia and epigastralgia, and invest in comprehensive oesophageal cancer services. Enhanced access and awareness of colonoscopy, standardisation of documentation and data management, implementation of quality indicators, and regular training are needed to improve patient outcomes.

Pulmonary Function Tests: A Tool to Assess the Lung Functional Capacity in Different Physiological and Disease Conditions

Mohd. Amir — Sat, 14 Mar 2026 00:00:00 +0000

Pulmonary function tests are tests to assess pulmonary function. These tests assess every aspect of our lung function. It assesses lung compliance (dynamic as well as static), degree of airflow obstruction, exchange of gases and other functions. Pulmonary function tests are non-invasive and safe, as there is no requirement of insertion of any instrument inside the human body by a health care provider. The study evaluates the importance of Pulmonary Function Tests to assess the Lung Functional Capacity in different physiological and disease conditions. There is a battery of tests to assess both static and dynamic lung function. Dynamic lung function tests mainly measure airflow rate, while static lung function tests measure absolute air volumes. Some tests are used to measure how well our lungs absorb oxygen in blood. Some others test the response of lungs to some triggers, like exercise and pharmacologic agents. Pulmonary function tests are variable in different physiological states like age, sex, exercise, change of posture, pregnancy, etc., as well as in pulmonary diseases. Pulmonary diseases are broadly classified into two categories: first, restrictive lung diseases, e.g. interstitial lung disease, scoliosis, etc. and second, obstructive lung diseases, e.g. asthma, bronchitis, bronchiectasis, etc. In obstructive lung diseases, mainly dynamic lung functions are affected, but in restrictive lung diseases, static lung functions are mainly affected. FEF_25-75%is the most sensitive parameter for early diagnosis of obstructive lung disease, whereas DLCO is the most sensitive for early diagnosis of restrictive lung disease.

Dieulafoy’s Lesion as An Important Cause of Obscure GI Bleeding: A Case Report

Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar, Musarrat Mahtab — Sat, 14 Mar 2026 00:00:00 +0000

Dieulafoy's lesion is a rare but serious cause of gastrointestinal bleeding, typically affecting older adults. It involves an aberrant arteriole eroding the gastric mucosa, resulting in severe, recurrent bleeding that poses diagnostic and management challenges. A review of the literature revealed that, since the original description of Dieulafoy’s lesion over 100 years ago, only 280 cases had been reported worldwide up to 2010. From Bangladesh, only two cases have been reported, both described recently. This study reported the case of a female in her mid-sixties who presented with melena. She had coexisting left heart failure and chronic kidney disease. Initial and repeat upper GI endoscopies were negative, but a subsequent emergency endoscopy revealed bleeding from two sites near the gastroesophageal junction. Hemostasis was achieved with argon plasma coagulation, and Dieulafoy’s lesion was identified as the cause of her recurrent GI bleeding. This case highlights the importance of considering Dieulafoy’s lesion (DL) in the differential diagnosis of gastrointestinal haemorrhage, as it can cause significant morbidity, weight loss, and may be missed during initial investigations. Therefore, DL should be emphasised in postgraduate medical curricula and always considered in patients presenting with GI bleeding.

Hypereosinophilia as a Presentation of IGH-Rearranged B-Cell Acute Lymphoblastic Leukaemia: A Comprehensive Review

Sat, 14 Mar 2026 00:00:00 +0000

B-cell acute lymphoblastic leukaemia (B-ALL) harbouring immunoglobulin heavy chain (IGH) gene rearrangements encompasses a clinically and molecularly heterogeneous group of haematological malignancies. Among these, the subset presenting with hypereosinophilia represents a particularly underrecognised diagnostic challenge, frequently resulting in significant delays to appropriate treatment. The paradigmatic example is B-ALL with t(5;14)(q31.1;q32.3)/IGH::IL3, in which dysregulated interleukin-3 (IL-3) expression driven by the IGH enhancer leads to pronounced reactive eosinophilia that may entirely dominate the clinical picture. The leukaemic blast burden at presentation may be deceptively low, and the eosinophilia—reactive rather than clonal—can divert clinical attention towards primary eosinophilic disorders, myeloid neoplasms with eosinophilia, or common reactive causes including parasitic infection and atopy. Beyond the IGH::IL3 fusion, other IGH partner genes, including CRLF2, EPOR, and DUX4, create signalling environments that may further potentiate eosinophil recruitment and bone marrow expansion. Accurate diagnosis requires the integration of peripheral blood film morphology, multiparameter flow cytometric immunophenotyping, conventional cytogenetics, fluorescence in situ hybridisation (FISH), and, increasingly, next-generation sequencing (NGS) or transcriptomic profiling. Treatment of the underlying leukaemia with standard multi-agent B-ALL chemotherapy regimens remains the definitive approach, resolving the associated eosinophilia as the leukaemic clone is suppressed. Emerging immunotherapeutic agents and targeted kinase inhibitors are reshaping the treatment landscape for molecularly defined B-ALL subtypes. This comprehensive review synthesises current knowledge of the molecular pathogenesis, clinical presentation, diagnostic challenges, and therapeutic strategies for this underrecognised entity, with the dual aim of heightening clinical awareness and reducing diagnostic delay.

Superior Sagittal Sinus: Normal and Varied Anatomy and Associated Clinical Implications

Rajani Singh, K. C. Thakur — Sat, 14 Mar 2026 00:00:00 +0000

The superior sagittal sinus is the largest venous sinus enclosed in two layers of the dura mater and situated in the midline in the groove in the parietal bone. The superior sagittal sinus drains blood from the cerebral hemisphere of the brain. It begins at the foramen cecum anteriorly and ends at the confluence of sinuses posteriorly. The superior sagittal sinus is divided into three types, namely, the anterior part extending from the foramen cecum to bregma, the middle part extending from bregma to lambda and the posterior part spanning from lambda to confluence of venous sinuses.

The anatomical variations of the superior sagittal sinus are common and may involve any of the three parts mentioned, but most commonly involve the cranial part of the superior sagittal sinus. Various variations observed in the cranial part of the superior sagittal sinus include hypoplasia, which may be unilateral or complete and duplication. These variations are important for neurologists and radiologists as they may be mistaken for venous sinus thrombosis, leading to misdiagnosis and mismanagement. The chapter throws light on the normal configurations, variations in its configuration, embryological aspect along with the repercussions of the varied configuration of the superior sagittal sinus. Knowledge of the anatomical variations of the dural venous sinuses is clinically significant during neurosurgical procedures involving the cranial cavity. For surgical resection of the petroclival meningiomas, the information regarding the patterns of drainage of the confluence of sinuses is of paramount importance. Lack of awareness of the detailed anatomy of the dural venous sinuses may lead to misinterpretation of radiographs of the posterior cranial fossa and subsequent mismanagement. Therefore, comprehensive knowledge of the anatomical variations of the superior sagittal sinus is essential for accurate radiological interpretation and safe neurosurgical intervention.