Personality

Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence.

Rates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and facilitators to accessing dementia care have been explored from the viewpoint of migrants and caregivers, however, no review has synthesised the literature pertaining to clinicians' viewpoints. This review aimed to explore clinician perspectives as to the barriers and facilitators in assessing and diagnosing dementia in migrant populations.

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.

Among patients with chronic kidney disease stage-5 who are treated with dialysis, the urea clearance during hemodialysis is a determinant of the mortality. Decreased serum albumin, serum calcium but increased phosphorus is associated with reduction of URR and mortality in these patients. This study was to compare two groups Urea Reduction Ratio (URR) and different type of biochemical parameters. URR was aimed to target according to Kidney Disease Outcomes Quality Initiative (KDOQI) guideline. This study was an observational study was carried out in the department of Nephrology. Serum Albumin, serum calcium, phosphate, hemoglobin and pre dialysis urea, post dialysis urea were measured from blood sample. URR was calculated by = (1- postdialysis urea/predialysis urea) × 100. Among the patients who under went hemodialysis, 17.31% patients URR was more than 65.0% and Mean±SD of URR was 67.21±1.9%. On the other hand, 82.68% patients URR was less than 65.0% and Mean±SD of URR was 57.4±5.2%. Most of the Biochemical parameters in this study were significantly different between two groups. Where as, there was no significant difference in Age, Sex, Body Mass Index (BMI). The URR is an accurate indicator, can help determination of adequate dialysis. This study aimed to find out the mean value of the urea reduction ratio and the association of biochemical parameters among End Stage Renal Disease (ESRD) patients on maintenance hemodialysis.

An anal fissure is a small cut or tears in the skin or mucosal lining of anal passage or at the opening of anus. It affects the quality of life due to severe pain and sometimes causes bleeding also while passing the stool. It can affect people of any age. In recent time, laser treatment creates a new era for management of anal fissure. It is easier, safer, faster for the treatment of chronic anal fissure. The aim of the study was to evaluate short term and long term clinical and surgical outcome of laser treatment. In this prospective study total 82 patients with chronic anal fissure underwent laser treatment from July 2019 to June 2020 at Anower Khan Modern Medical College Hospital and Care Medical College Hospital, Bangladesh. All the patients who completed their 1.5 months and 6 months follow up were included for the study and their data was analyzed. Out of 82 patients, 71 were females and 11 were male. The mean age 40.31±9.23, mean operative time was 15.0±10.0 minutes. Mean hospital stay 24.35±1.23 hours (1 day). Mean healing time was 14.03±12.04 days. All patients were followed upto at outpatient clinic 1.5 and 6.0 months postoperatively. This study shows that laser treatment is a simple, safe, and effective procedure to treat the anal fissure with a low rate of complications. It can be treated as an effective treatment for patients with chronic anal fissure. However, this procedure has some limitations.

The cross sectional, analytic and descriptive type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh District (Fulbaria, Trisal, Haluaghat, Fulpur and Muktagacha), Bangladesh on 109 Bangladeshi children from January 2016 to December 2016. Nonrandom purposive sampling technique was taken for sample collection. Any kind of foot deformity resulting either from physical injury or congenital anomaly was excluded to construct standard data. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding great toe length, to measure correlation of stature with great toe length and comparison of great toe length between male and female children. This study has been made out to grow interest among the researchers for future study of different country. Stature of the subject was measured with the stadiometer and great toe length was measured using slide caliper. The children were requested to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean great toe length of both sides of 5, 6, 7, 8, 9 and 10 years aged male were 2.90±0.51 cm, 3.00±0.38 cm, 3.18±0.42 cm, 3.41±0.26 cm, 3.34±0.32cm and 3.57±0.45 cm respectively and those of female were 2.93±0.70 cm, 2.70±0.43 cm, 3.05±0.37 cm, 3.02±0.25 cm, 3.42±0.55 cm and 3.62±0.44 cm respectively. Great toe length showed non-significant positive correlation with stature in 5 years old female, 7 years old male and female, 8 years old male, 9 and 10 years old male and female children. In 5 years old male, 6 years old male and female and 8 years old female children, great toe length showed non-significant negative correlation with stature. Comparison of great toe length between male and female children was done by Unpaired Students 't' test which was statistically non-significant.

The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.

A baby's weight at birth is an important predictor of infant growth and survival. Low birth weight leads to an impaired growth of the infant and its attendant risks of a higher mortality and morbidity. Various studies found higher maternal plasma homocysteine level was associated with lower offspring birth weight. Therefore, this study was carried out to find out association between maternal serum homocysteine and birth weight. A cross sectional study was conducted in the Department of Obstetrics and Gynaecology, BSMMU from September 2018 to August 2019. Pregnant women at their third trimester between 37-40 weeks admitted to in patient Department of Obstetrics and Gynaecology, BSMMU were included in this study. Ethical committee clearance was obtained from the institution. After matching eligibility criteria informed written consent were taken from the patients. Data was collected from the patients using the structured design by interview, observation, clinical examination and haematological investigations. The serum homocysteine level of these patients and birth weight of their babies was measured immediately after delivery. Negative correlation was found between maternal serum homocysteine level and neonatal birth weight, (r = -0.419, p<0.05). During regression analysis maternal homocysteine and gestational age was found significant when adjusted with maternal age, parity, maternal BMI and sex of the baby. So, increased maternal serum homocysteine is negatively associated with low birth weight babies.

Oral contraceptives pills (OCPs) are one of the most commonly used methods of birth control by women worldwide. Presently, worldwide about 100 million women are current users of combined hormonal contraceptives (COC) most frequently used in the western world. The most frequently used agents are a combination of drugs containing both an estrogen and a progesteron. This combination is considered to be highly efficacious, generally considered 99.9% and a use effectiveness of 97.0% to 98.0%. This study was done to find out the association of serum total cholesterol and blood pressure in combined oral contraceptive pill users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh between the periods from July 2021 to June 2022. A total number of 120 reproductive aged women, age ranged from 15-55 years were included in this study. They were divided into two group, sixty (60) combined oral contraceptive pill users were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test and pearson's correlation coefficient test. Pearson 'r' value of systolic blood pressure and diastolic blood pressure are 0.582 and 0.416 respectively indicates positive correlation with serum total cholesterol. Correlation is statistically highly significant (p<0.001). Blood pressure and serum total cholesterol were positively connected in study group in comparison to control group respectively. So from this study, it can be concluded that there is a significant association between serum total cholesterol and blood pressure with oral contraceptives.

Now a days, chronic obstructive pulmonary disease (COPD) is a global health problem. This study was done to evaluate the changes of body mass index (BMI) and blood pressure (BP) in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the periods from July 2018 to June 2019. Total 160 male subjects, age ranged from 30-70 years was included in this study. Among them, in study group (Group II) eighty (80) male COPD subjects and eighty (80) age matched male healthy subjects were taken as control group (Group I). BMI was calculated as weight in kilogram divided by the height in meter square. Blood pressure was measured with an aneroid sphygmomanometer. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of BMI of Group I and Group II were 24.52±1.35kg/m² and 21.22±1.30kg/m² respectively. The mean±SD of systolic blood pressure of Group I and Group II were 118.75±7.73 mm of Hg and 134.56±15.24 mm of Hg respectively. The mean±SD diastolic blood pressure of Group I and Group II were 77.63±6.70 mm of Hg and 84.69±8.05 mm of Hg respectively. The mean±SD of BMI was significantly lower in study group and the mean±SD of systolic and diastolic blood pressure was significantly higher in study group than control group. Low BMI and hypertension in subjects with COPD are associated with a high risk of exacerbations and mortality. So assessment of this parameter is important for prevention of complication related to COPD for leading a healthy life.

The presence of bright resonance of more than 1 mm or more cusps of the aortic valve, mitral valve or mitral annulus is termed as cardiac valve calcification. If an intense echo producing structure located at the junction of the atrioventricular groove and posterior mitral valve leaflet on Echocardiography that is Mitral annular calcification (MAC). This study was conducted to observe the association of MAC with clinical and echocardiographic findings of ischemic heart disease (IHD) and the role of trans-thoracic echocardiography to detect MAC which is a marker IHD. In this prospective, observational, case-control study, total of 100 IHD patients, 50 patients with MAC were assigned as case group and 50 patients without MAC were control group after fulfilling inclusion criteria. All the detailed history, clinical examination and relevant investigation reports of each patient were recorded in pre designed data collection sheet. MAC was detected with transthorasic echocardiography. Analysis was done to observe the association and correlation of MAC with clinical findings of IHD. Mean age of the case control was 55.16±10.73 years and control was 49.80±8.84 years. MAC was noted highest about 56.0% in between age 45 to 60 years. Eighty two percent (82.0%) of cases and 84.0% of controls were male, 18.0% of cases and 16.0% of controls were female. BMI among the MAC group 2.0% were underweight, 72.0% normal, 24.0% over weight and 2.0% were obese and among non MAC controls group 10.0% were underweight, 68.0% normal, 20.0% over weight and 2.0% were obese. Clinically among cases 14(28.0%) had Stable angina, 8(16.0%) had UA, 3(6.0%) had Non STEMI, 2(4.0%) had AMI, 2(4.0%) had Recent myocardial infarction and 21(42.0%) had OMI. Diabetes mellitus was significantly higher in the case groups (p=0.006). Significant p-value was noted in hyper-triyglyceridemia and low HDL in case group than control. Echocardiographic studies showed 52.0% of cases and 32.0% of controls had regional wall motion abnormality (RWMA). Transthorasic echocardiographically detected MAC is an independent predictor of Ischemic heart disease. The low cost, portable and radiation free nature of the ultrasound approach make MAC an attractive parameter in the ongoing search for IHD.

In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. Over last two decades there is predominance of Non albicans Candida (NAC) infection with increased isolation of novel species and decreased susceptibility. Early identification of Candida species and determination of antifungal susceptibility pattern is essential for effective management. Therefore, the study was conducted to isolate and identify Candida species from the blood samples of the patients suspected of candidemia and assess their antifungal susceptibility pattern. This cross-sectional, descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Venous blood was collected from clinically suspected patients admitted at ICU, Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital, Bangladesh. Primary blood culture was performed by automated method followed by sub-culture in Saboraud's Dextrose Agar (SDA) and blood agar media. Candida species were recognized by phenotypic and genotypic methods. Antifungal susceptibility testing was done by disk diffusion and broth microdilution method (BMD). Out of 125 blood specimens collected, Candida species were isolated from 39(31.0%) blood samples of which NAC species were 35(89.0%) whereas C. albicans was only 4(10.2%). Eight (8) different Candida species were identified of which C. parapsilosis was predominant 16(41.0%). Rare and emerging drug resistant species of C. ciferrii 23.0%, C. auris 7.7%, C. rugosa 10.3%, C. lusitaniae 2.6% were also isolated. Candidemia was highest in neonate 33(84.61%) with male predominance 24(61.54%). Use of broad-spectrum antibiotics, prolonged hospital stay, pre-maturity and low birth weight (LBW) were found to be important risk factors. In candidemia the highest resistance was to Fluconazole-33% and lowest to Voriconazole-5%. The study showed that NAC species were more common with emergence of rare and multidrug resistant species.

Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal women. The spectrum of AUB in women of our country includes a wide varieties of organic pathology. The objective of this study was to assess the role of endometrial thickness as a predictor of endometrial malignancy among the women presenting with AUB. This cross-sectional descriptive type of observational study was conducted among 122 women of perimenopausal (40-50 years) and 87 women of postmenopausal (>50 years) age group presenting with AUB in the Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Bangladesh from February 2020 to August 2021. These patients were subjected to a detailed history and meticulous general, systemic and local examination. The relevant investigations like Transvaginal Sonography (TVS) followed by endometrial biopsy by dilatation and curettage were done in all study participants. Most of the women were in the age group 41-45 years in perimenopause and 51-55 years in postmenopause. Mean±SD was 45.8±4.1 years in perimenopause and 56.3±6.4 years in postmenopause. There was statistical significance in developing endometrial malignancy regarding risk factors of nulliparity, Hypertention (HTN), Diabetes mellitus (DM) and hormone intake between perimenopause and postmenopause. Endometrial thickness was measured in perimenopause and postmenopause. Mean±SD of Endometrial thickness (ET) in perimenopause and postmenopause was 11.3±4.4mm and 7.2±6.3mm with statistical significance (p<0.001). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy of TVS were 85.5%, 67.4%, 81.2%, 73.8% and 78.7% in perimenopause and 85.9%, 20%, 89%, 75% & 83.9% in postmenopause. Cut off limit of ET in detection of endometrial malignancy was 18.5mm with sensitivity 74.8% and specificity 63.6% in perimenopause and 12.2mm with sensitivity 81.0% and specificity 65.8% in postmenopausal women. Women with AUB, endometrial malignancy should be suspected when endometrial thickness on TVS >18.5mm and >12.2mm in perimenopause and postmenopausal age group respectively. TVS has high sensitivity in detection of endometrial malignancy both in perimenopausal and postmenopausal women with AUB and TVS is a reliable, noninvasive method.

The bicipital groove is a groove on the anterior aspect of the proximal end of the humerus. It lies between the greater and lesser tubercles. The variations of this groove may lead to various pathologies of the biceps brachii tendon, one of the most common causes of shoulder pain. Hence, this study examines the various osteometric parameters of bicipital groove in the Bangladeshi population. This cross-sectional descriptive study was done on 100 dry adult human cadaveric humeri (43 right sides and 57 left sides) in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. The length, maximum width and depth of the bicipital groove and the length of this groove's medial and lateral walls were measured using a digital Vernier slide caliper. Data were recorded in a predesigned data sheet separately and analyzed statistically using Microsoft Excel and SPSS. According to the present study, the mean±SD length of the bicipital groove of the right humeri was 66.646±11.563mm and the left humeri were 66.002±13.025mm. The mean±SD maximum width of the bicipital groove of the right humeri was 10.870±1.799mm and the left humeri were 11.480±1.402mm. The mean±SD depth of the bicipital groove of the right humeri was 4.242±0.655mm and the left humeri were 4.452±0.854mm. The mean±SD medial wall length of the bicipital groove of the right humeri was 60.671±12.360mm and the left humeri were 59.161±13.660mm. The mean±SD lateral wall length of the bicipital groove of the right-sided humeri was 64.996±11.611mm and the left humeri were 64.074±13.115mm. It is expected that this osteometric study of bicipital groove among the Bangladeshi population will be very helpful for clinical anatomists, orthopaedic surgeons, anthropologists and radiologists.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of airflow limitation that is not fully reversible. COPD affects the lungs and produces significant systemic consequences. In Bangladesh, the prevalence of COPD after 40 years of age is 21.24% and the general population is 4.3%. COPD leads to a sedentary life, which reduces the functional status of the individual. Functional status assessment is vital for appropriate therapy and rehabilitation programs in COPD patients. A Sit-to-stand test (STST) has been proposed as a better alternative to 6MWT, but a Squat-to-stand test (SqTST) to test their ability to stand from the squatting position will be more appropriate in rural patients. This study was conducted using a cross-sectional observational design from July 2020 and September 2021 in the Department of Respiratory Medicine at the National Institute of Diseases of the Chest and Hospital, Bangladesh. Sixty (60) diagnosed cases of COPD patients were enrolled in this study. Severities of airflow obstruction according to GOLD were categorized on the basis of post-bronchodilator FEV₁ by spirometry. SqTST was performed on all patients, and functional status was recorded. All data were collected using a preformed questionnaire. Statistical analyses of the findings were carried out using SPSS version 23.0. In this study, the majority of 21(35.0%) patients had very severe COPD, and almost half (48.3%) of the patients had abnormal SqTST. A significant relation was found between the severity of COPD with SqTST (p=0.001). Based on the receiver-operator characteristic (ROC) curve, SqTST had an area under curve 0.901. SqTST had 82.1% sensitivity, 85.7% specificity, 83.3% accuracy, 91.4% positive predictive value, and 72.0% negative predictive value to find severe COPD cases in stable COPD patients. ROC was constructed using SqTST, which gave a cut-off value <7.0, with 82.1% sensitivity and 85.7% specificity for predicting severe COPD. From this study, it may be concluded that SqTST is a clinically useful tool to assess the functional status of stable COPD patients.

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease with unknown etiology. Some previous studies suggest that elevated serum homocysteine level is a risk factor for stroke, ischemic heart disease; atherosclerosis and neurodegenerative diseases like Parkinson's disease. Serum homocysteine level relates with Parkinson's disease through various mechanisms including gene defect, apoptosis, oxidative stress and DNA damage. Some recent studies reveal that serum homocysteine level is elevated in Parkinson's disease patient compared to healthy individuals. This study was aimed to compare the serum homocysteine level in Parkinson's disease patients and age and sex matched apparently healthy individuals. This was a case control study which was conducted in Department of Neurology and Medicine, Mymensingh Medical College Hospital, Mymensingh during November 2019 to April 2021. Total 55 cases of Parkinson's disease patients and age and sex matched 55 apparently healthy controls were enrolled in this study. Demographics and clinical data were collected using structured case record form and adopting purposive type of sampling method. Serum homocysteine level was measured in both case and control groups. The study reveals that, average age of the patients and control group was in sixth decade. Male predominance was found with male to female ratio was 1.5:1 in case group. Both groups showed almost similar demographic profiles. Twenty-nine (52.72%) patients of Parkinson's disease observed higher serum homocysteine level in contrast to only 8(14.54%) in control group. The mean serum homocysteine ±SD was 15.43±6.04μmol/L in case group and 10.04±5.31μmol/L in control group; the difference was statistically significant (p=0.001). Mean serum homocysteine levels were measured progressively higher with increased duration and advanced stages of disease. It was concluded that, serum homocysteine level is higher in Parkinson's disease patients than normal healthy individuals. In addition, there was significant positive correlation of elevated serum homocysteine with increased duration of Parkinson's disease and advanced stages of the disease.

Parieto-occipital sulcus is one of the major sulcus of the cerebral hemisphere which separates the occipital lobe from the parietal lobe. Morphology of this sulcus varies with age, sex, manual skill, handedness and in many diseases. For various clinical investigations and surgery, detailed morphological knowledge of this sulcus is very much essential for the surgeons and radiologists. This study is carried out to establish a normal standard in length of the parieto-occipital sulcus in different age and sex groups of Bangladeshi people. A cross-sectional, descriptive type of study was conducted in the department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to July 2017. About 60 specimens were collected from medico-legal cases and divided into four age groups including, Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50 years and above). The mean length of parieto-occipital sulcus was 3.92±0.559cm to 3.29±0.434 cm in male and 3.81±0.715cm to 3.03±0.551cm in female. The difference in mean length of the parieto-occipital sulcus for both left and right hemisphere between male and female was statistically non-significant in all age groups. For statistical analysis, differences between age and sex groups were analyzed by using students unpaired 't' test. In this study, the length of the parieto-occipital sulcus showed gradual decreasing values with advancing age.

Burns are very common and important injuries associated with epilepsy. Epileptics are afflicted with burns when they come in contact with fire or other burning agents while seizing, due to loss of consciousness. The aim of the study was to identify the causes of burn, pattern and characteristics of burn in patients with epilepsy, duration of hospital stay and pattern of treatment in these patients. This prospective observational study was conducted in the Department of Burn and Plastic Surgery, Mymensingh Medical College Hospital, Bangladesh from January 2022 to December 2023. Epileptics were found in 0.84% (n=19) of the total admission (2274) in Burn unit. Majority of the patients were females (84.2%) and the mean age was (31.42±1.32) years. Maximum patients were housewives (78.9%). Among 19 cases, 11 cases (57.89%) had history of irregularly taking antiepileptic drugs and 8 cases (42.11%) had no history of treatment for epilepsy. Two cases (10.53%) had history of previous burn injury. Flame burn was the major etiology (89.5%). Mean total burn surface area (TBSA) was (6.94±4.12%). Most patients had full thickness burns (63.2%). Regarding distribution of burn, maximum involvement was in upper limb i.e. 68.21% cases. Surgical treatment was needed in the majority of the patients (68.5%). Mean hospital stay of these patients was (5.36±2.26) weeks. Epilepsy patients whose seizures are inadequately controlled are at increased risks of injury, especially burn. For prevention of burn, epilepsy should be treated properly.

Coronavirus disease 2019 (Covid-19) disease have been associated with significant mortality amongst doctors globally including Bangladesh. To delineate the clinico-epidemiological characteristics of the physician affected with Covid-19 was the objective of the study. This cross-sectional 'Facebook' based survey was conducted in the period of August 2020 to September 2020. Snowball sampling methods was followed. A total of 151 physicians affected with Covid-19 participated in this survey. Self-reported perceived severity scale (zero meaning not severe at all and ten denoting the most severe) was used. Collected data were analyzed by SPSS 25.0. Among the participants, the majority were male, 98(64.9%). The most prevalent affected age groups were 24-35 years 131(86.8%). Approximately 45.0% worked in COVID dedicated hospital. Entry-level physicians (Medical Officer or Assistant Surgeon) were the most affected 117(94.4%). One-third of the physicians had at least the one co-morbidity. Bronchial asthma, obesity and diabetes were the most frequent. Predominate symptoms of the infection were fever 94(62.3%), cough 94(62.3%) and myalgia 92(60.9%). Half of the participants had sore throat, anosmia, gastro-intestinal symptoms and one-third of the patients developed dyspnea. Perceived severity of the symptoms ranged between 2 and 6. The pattern of drug use to prevent the Covid-19 showed no uniformity. However, intake of Zinc, Vitamin C, Vitamin D, antihistamine and Ivermectin was found in 74.8%, 67.5%, 41.7%, 49.0% and 37.7% respectively. As the current pandemic continues to evolve, physicians must be equipped with appropriate knowledge, skills and must be cautious on the prevention measures against Covid-19.

Major causes of acute insult in Hepatitis B virus related acute on chronic liver failure in the Asian region are reactivation of Hepatitis B virus and super infection with hepatitis A and E virus (ACLF). Anti viral therapy should be started as soon as possible in the ACLF patients at presentation while waiting for confirmation by HBV DNA level. This randomized controlled trial was carried out at the Department of Hepatology, BSMMU, Bangladesh from September 2019 to august 2020 with Hepatitis B virus related ACLF patient. This trial was conducted among twenty seven HBV acute on chronic liver failure patient to compare Child Turcotte pugh (CTP) score, Model for end stage liver disease (MELD) score, Asia Pacific Association for study of Liver (APASL) ACLF Research consortium (AARC) score, survival of the patients and HBV DNA level at 3 months with antiviral therapy between tenofovir alafenamide (25mg) and entecavir (0.5mg) group. CTP score, MELD score and AARC score were significantly (p<0.05) decline from baseline to all subsequent follow-up at 1st (at 7 days), 2nd (at 14 days), 3rd (at 30 days) and 4th (at 90 days) in each group but non significant (p>0.05) difference occurred between two group. All twenty seven patients had detectable HBV DNA level at pre-treatment and all survived patients became undectable at 4th, 90 days follow-up. Total 10 patients (37.07%) were survived at 90 days follow-up, out of them seven patients (70.0%) were in tenofovir alafenamide group and three patients (30.0%) were in entecavir group which was statistically significant (p<0.05) in between two group. Hepatic encephalopathy and hepatorenal syndrome were most common causes of death in both groups. Both drugs tenofovir alafenamide and entecavir significantly improves liver functions but the former one is superior regarding survival.

The extremely contagious global outbreak of the novel Coronavirus disease 2019 (Covid-19) caused by Severe acute respiratory syndrome coronavirus-2(SARS- CoV-2) is causing concern worldwide since its emergence. Healthcare workers (HCWs) are more susceptible for acquiring Covid-19 due to direct or indirect exposure to Covid-19 patients. Therefore, it is important to investigate demographic, clinical characteristics and outcome of affected persons and possible source of infection with exposure details. This study aimed at determining the demographic and clinical profile, outcome and possible risk factors for infection among the HCWs at Kurmitola General Hospital (KGH), Bangladesh. This retrospective observational study was done among the SARS-CoV-2 positive HCWs of Kurmitola General Hospital (KGH) from April 2020 to January 2021. Out of total 1323 HCWs, 180(13.9%) cases were detected Covid-19 positive. Among the infected HCWs, 76(42.2%) were male and 104(57.8%) were female. The mean age was 32.8±6.95 years. Eighty nine (89) were nurses (49.4%) and 67 were physicians (37.2%). Among them, 23(13.0%) had no definite symptoms. Mild symptoms had in 137(76.11%) and 40(22.22%) had moderate symptoms. Most common symptoms were fever 112(62.0%), weakness 108(60.0%), cough 102(57.0%) and myalgia 54(30.0%). Pre-existing comorbidities had 43(24.0%). Bronchial asthma 27(15.0%), HTN 24(13.0%) and DM 21(12.0%) were the most prevalent comorbidities. All completely were recovered ultimately. Fatigue 52(28.89%), shortness of breath 15(8.3%), cough 13(7.2%) were the most common long-term complications. Among them, 53(29.0%) pointed toward lack of maintaining a hygienicatmosphere, as their possible cause of being infected, whereas 37(21.0%) could not identify the cause. Maximum HCWs, 170 cases (94.44%) used PPE during their duty. Adequate training get 26(14.44%) on PPE use and Infection prevention and control (IPC). This study concludes almost 1.4 in 10 HCWs at KGH were infected with SARS-CoV-2 while working in hospital during the Covid-19 pandemic. Affected HCWs have relatively female predominance with younger age, milder symptoms, and less underlying diseases in this study. Fatigue and shortness of breath are most common long-term complications, which hampers their working ability. Most of them did not get any training on PPE use and IPC.

Rectal malignancies that require abdominoperineal resection (APR) and Anterior resection (AR) is very common. Laparoscopic APR or AR can be a better option. This study observed the feasibility of this newer technique for alternative to conventional open method. This prospective type of observational study was comprised of patients with diagnosis of rectal cancer, who admitted to BIRDEM General Hospital for Laparoscopic APR or AR from November 2015 to April 2016. Among 19 patients, age range was from 20-78 years, mean age was 49.84±17.04 years. Male: female ratio was 12:7 (63.2%:36.8%). Twelve (12) patients underwent Laparoscopic APR, 6 Laparoscopic AR, one conversion (conversion rate - 5.3%). Less analgesics were required, a mean of 5.61±1.57 dose/ample/mg opioid injections needed for 4.05 days. An early postoperative ambulation (2.16±0.76 days) was noted. Mean post-operative hospital stay was 11.53±1.98 days. Laparoscopic APR or AR is a safe, effective and technically feasible procedure. It can be a better operative procedure in terms of early postoperative outcome such as less analgesics requirement, early ambulation and shorter hospital stay.

Exudative pleural effusion appears as manifestation of underlying specific disease process and pleural biopsy is usually enough to find out the underlying causative disease. The aim of the study was to find out the efficacy of needle biopsy of pleura in the aetiological diagnosis of pleural effusion. This cross-sectional study was conducted for a period of one year from January 2008 to December 2008 in the Department of Medicine, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh enrolling 50 subjects with exudative pleural effusion. The cases with transudative pleural effusion were not included. Needle biopsy was done in all the cases. Histopathological reports of pleural biopsy specimen were correlated with other data and analyzed to detect the causes of effusion. Major incidence of malignant effusion occurred between 41 to 70 years of age. No malignant effusion was found before 30 years of age. Incidence of tuberculous and malignant pleural effusion was much more common in males than in females. Sensitivity and specificity of combined pleural biopsy and pleural fluid analysis in the diagnosis of pleural effusion was 97.06% and 100.% for tuberculosis and 81.82% and 100.0% for malignancy. The present study reveals that pleural biopsy was very effective method in the diagnosis of cause of pleural effusion.

Construction work is common all over the world. Construction workers are exposed to various physical, chemical, biological and ergonomic hazards that may directly affect respiratory health. Aim of the study was to assess construction workers' pulmonary function and compare pulmonary function with healthy volunteers. This cross-sectional study was carried out in the Department of Physiology ARMCH & RC, Solapur, India from March 2022 to March 2023 on construction workers (n=25) and healthy subjects (n=25). Pulmonary function assessment in both groups was done using a Spiro Excel machine spirometer. The comparison was made between both groups for frequency of respiratory symptoms, spirometry pattern, and spirometry values. Statistical software used unpaired t-test and chi-square test. A normal pattern was observed in 40.0% of healthy subjects compared to 72.0% of construction workers (p<0.05). Restrictive and mixed patterns were evident in 4.0% and 1.0%, respectively, in healthy volunteers compared to 11.0% and 3.0% in construction workers (p<0.05). Statistical difference was seen in all lung function parameters, i.e. FVC, FEV₁, FEV₁/FVC%, FEF 25.0-75.0%, PEFR except MVV between both groups. In conclusion the construction workers are at risk of respiratory function derangement. This derangement is in the form of increased frequency of respiratory symptoms, restrictive & mixed patterns and decreased spirometry values of various parameters.

Physical activity and mindfulness techniques, such as exercise and Kapalbhati Pranayama, are known to have positive effects on health and well-being. However, limited research has directly compared their impact on physiological and psychological parameters. This study aimed to investigate and compare the effects of exercise and Kapalbhati Pranayama on Heart Rate Variability (HRV) and Electroencephalogram (EEG) activity, shedding light on their contributions to overall health and mental well-being. The study was conducted at All India Institute of Medical Sciences (AIIMS) in Bhopal, India, from 2018 to 2022. A prospective interventional design was employed over two months, involving 20 participants with normal BMI and no respiratory or cardiac conditions. Exclusion criteria included lung or cardiac diseases, smoking history, dyspnoea during physical activity, pedal edema, and high blood pressure. The Kapalbhati Pranayama intervention was supervised and limited to 5 minutes. HRV was assessed using the HRV Brain Tap Neuralchek Machine before, during, and after Kapalbhati. For exercise, a mild-intensity cycling protocol was performed on healthy volunteers aged 20 to 50. HRV was recorded before, during, and after exercise. The EEG analysis revealed notable changes in brain wave patterns. At baseline, participants exhibited higher levels of delta, theta, and alpha waves, indicating a state of relaxation and calmness. During exercise, there was a significant increase in beta waves and a decrease in delta, theta, and alpha waves, reflecting heightened brain activity and alertness. After Kapalbhati, beta wave levels remained elevated, while delta and theta wave suppression was more pronounced, suggesting a stimulating effect on the brain similar to exercise. The changes in beta and gamma EEG waves could be attributed to factors such as exercise intensity, duration, frequency, and the release of endorphins during both exercise and Kapalbhati. The HRV analysis demonstrated distinct responses to exercise and Kapalbhati. Exercise led to a significant reduction in HRV parameters, characterized by increased heart rate and decreased time-domain HRV measures, aligning with the typical sympathetic nervous system dominance during physical activity. In contrast, Kapalbhati's impact on HRV parameters was milder, with minor changes in heart rate and subtle alterations in time-domain HRV measures. The high LF/HF ratio during Kapalbhati suggested a potential stimulation of the sympathetic nervous system. More comprehensive research is required to confirm these findings and understand the long-term effects of Kapalbhati on HRV and cardiovascular health. This study contributes to the understanding of how exercise and Kapalbhati Pranayama affect both cognitive and cardiovascular aspects of health. It highlights that both interventions increase brain activity and alertness, but Kapalbhati may have a more potent effect. Exercise significantly reduces HRV parameters, indicating sympathetic nervous system dominance, while Kapalbhati has milder HRV effects. Further research with larger and more diverse populations is essential to confirm and expand on these findings, providing insights into optimizing cognitive function and cardiovascular health through tailored approaches of exercise and Kapalbhati Pranayama.

A young boy presented with features of non-traumatic Subarachnoid hemorrhage (SAH) with hematemesis and melaena. He has had past history of prolonged bleeding following cut injury even requiring blood transfusion after circumcision. On examination, he was found confused, severely anemic, with presence of neck rigidity and painful swelling of right knee joint. But no positive family history was found. Non-contrast CT scan showed SAH. Cerebral angiography showed no aneurysm but knee joint had features of hemarthrosis. He was resuscitated and hemophilia was diagnosed on the basis of clinical suspicion of clotting factor assay. Specific treatment started in collaboration with Department of Hematology. This is a rare presentation of hemophilia as well as very uncommon cause of non-traumatic non-aneurysmal SAH.

Autoimmune thyroiditis gradually destroys the thyroid gland leading to hypothyroidism and may even lead to papillary thyroid carcinoma. Deficiency of Vitamin D has been linked to development of autoimmunity. Single nucleotide polymorphisms of the Vitamin D receptor gene have associated with autoimmune diseases in several studies. In this hospital based non interventional cross-sectional study Vitamin D receptor gene was studied for FokI (rs2228570) polymorphism from purified DNA in forty-eight adult cases and fifty age and sex matched healthy controls. This study was conducted in the department of Biochemistry, Calcutta National Medical College, Kolkata, West Bengal, India from January 2021 to July 2022. Their DNA was isolated using phenol chloroform method and were analysed for the related single nucleotide polymorphism by restriction digestion using appropriate restriction enzymes after amplification by PCR. Differences in allele frequencies between two groups were estimated by chi square and odds ratio test. Any potential association between the vitamin D anti TPO antibody and thyroid hormone status with polymorphic variations were assessed by post hoc ANOVA among the three genotypes. The distribution of FF genotype was significantly higher among the case group (Χ²=10.2788, p=0.006). The odds ratio for the allele F was significantly higher in case group for a range of 1.97 to 5.94 for 95 percent confidence interval (Χ²=13.9678, p=<0.001). The genotype FF group had significantly lowest Vitamin D (p=0.008) and highest Anti TPO ab (p=0.031) compared to Ff and ff genotypes. Thus, significant association was revealed between the VDR gene Fok1(rs2228570) polymorphism and autoimmune thyroiditis with the predominance of FF genotype being a strong susceptibility factor for autoimmune thyroiditis and Vitamin D deficiency in the studied population of Eastern India.

Abdominal aortic aneurysm remains mostly asymptomatic. It is usually detected incidentally with imaging studies. Here we present a 55 years old hypertensive, non smoker, non diabetic, male patient who was diagnosed as a case of infrarenal abdominal aortic aneurysm. He was treated by endovascular means using endograft without laparatomy. Endografts were deployed through bilateral femoral artery cut down technique under general anesthesia. Completion angiogram following this endovascular aneurysm repair (EVAR) technique revealed good technical success with no endoleak. This hybrid procedure was performed in a cathlab having surgical instruments in hand. Three years after the procedure, patient is doing well.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital disorder that affects the female reproductive system and is characterized by an underdeveloped or absent uterus and vagina. A 17-year-old unmarried female was admitted into the Department of Endocrinology, Mymensingh Medical College Hospital, Bangladesh in November 2023 for evaluation of primary amenorrhea and poorly controlled diabetes mellitus. She was the 5th issue of non-consanguineous marriage delivered at term by normal vaginal delivery. Her growth pattern and developmental milestones were normal. She had no history of galactorrhea, chronic or cyclic pelvic pain, thyroid dysfunction, excessive exercise, psychiatric illness, or drug abuse. There was no history of such type of illness in her family. She was diagnosed with diabetes mellitus two years back without classic symptoms, and at that time, her blood glucose was 22 mmol/L. She was prescribed metformin and gliclazide. She had no history of hypoglycemia, hyperglycemic crises, or hospital admission. On examination, her body build and nutritional status were normal. Anemia, jaundice, edema, dehydration, lymphadenopathy, acne, hirsutism, acanthosis nigricans, abdominal striae and vitiligo were absent. Her blood pressure was 110/70 without the postural drop, thyroid gland was not enlarged, anthropometric measurements were normal and BMI was 18.4 kg/m2. Her tanner stage was P5 & B4. Genital examination revealed normal female external genitalia, and a blind vaginal pouch was found. Other systemic examinations revealed no abnormality. On laboratory reports, her blood glucose was uncontrolled (HbA1c-10.2%) with glycosuria. Thyroid function test and gonadal hormones were normal. Ultrasonogram of the abdomen revealed uterus, cervix, and upper part of the vagina are absent, and an ectopic left kidney.

Contrast material containing Iodine can cause parotitis. Here we present A 70 year's old man admitted to United Hospital Limited, Gulshan, Dhaka, Bangladesh on 5th May 2021 with the complaints of chest pain and shortness of breath and he was diagnosed as NSTEMI with ALVF. He was Covid 19 positive two weeks back. He underwent PCI to LM to LAD, LCX and RCA two years back. He had hypertension, diabetes mellitus and dyslipidemia. He was taking dual antiplatelet, beta-blocker, ACE inhibitor, statin, diuretic and anti-diabetic medication. His physical examination findings were reasonably normal. An electrocardiogram revealed bi-fascicular block and echocardiogram showed inferior wall and basal segment of inferior-lateral wall were hypokinetic. His high sensitive Troponin I was raised and serum creatinine was normal. This case report contains a case of bilateral parotitis following coronary angioplasty, subsided with conservative management. Possible reasons may be the direct toxicity or idiosyncratic reaction of the iodinated contrast agent.

Very early onset inflammatory bowel disease (VEO-IBD) is called when age of onset of IBD occurs below 6 years. Though it is rare, it has been increasing over last decade with decreasing age of onset. VEO-IBD is different compared with pediatric and adult-onset IBD in many aspects, including the disease type, location of the lesion, disease behavior and genetic susceptibility. These children with VEO-IBD are usually present with more severe disease than older children and adults. VEO-IBD is associated with monogenic defect. The thought of a monogenic cause of VEO-IBD was first confirmed by the detection of mutations of interleukin 10 (IL-10) receptor genes that cause impaired IL-10 signaling. Monogenic IBD possesses significant concern because it usually presents with refractory to conventional IBD treatment or fistulous Crohn's disease, so early treatment with biologics or an alternative approach such as hematopoietic stem cell transplantation (HSCT) might be looked-for. Before establishing IBD, we must think of more common diseases of this age group. Infection and Cow's milk protein allergy (CMPA) are two common conditions and it can cause severe colitis. Confirmation of chronic intestinal inflammation by endoscopies is of greatest significance for the diagnosis of IBD. There should be no age limit for performing endoscopies. Severe disease should be treated with biologic agents and surgery. Identification of genes associated with IBD leads to better understanding of its pathogenesis, which could help to provide more targeted interventions. We discuss the topic here to create awareness among Pediatricians so that the patients can be benefited.

This study was intended to evaluate the pathological outcome of cardiopulmonary bypass whilst considering socio-demographic variables and surgical technique on early postoperative results following coronary artery bypass graft (CABG) surgery in patients at a tertiary level hospital in Bangladesh. This observational study evaluated a total of 880 patients with ischemic heart disease in Bangabandhu Sheikh Mujib Medical University, Bangladesh from 2011 to 2019 who were undergoing an isolated CABG surgery. In this current study, the population divided into two groups- Group A: Off-pump CABG (n=440) and Group B: On-pump CABG (n=440). The mean age of the patients was 55.25±5.0 years in off-pump and 50.75±5.2 years in the on-pump group. Risk factors, including smoking, hypertension, and hyperlipidemia, were predominant in both study groups. Total operative time was notably higher in the on-pump CABG group. However, grafting time was more in the off-pump CABG procedures. Postoperative neurological deficits were higher amongst the on-pump CABG population. The mean time of mechanical ventilation, intensive care unit (ICU) stay, total hospital stay, and mortality was notably higher in the on-pump CABG group. Moreover, the number of mortalities in on-pump CABG patients was primarily due to the low output syndrome, failure of weaning from cardiopulmonary bypass (CPB) and sudden cardiac arrest. Off-pump CABG is now more acceptable due to its potentiality to avoid CPB induced complications, aortic cannulation, and cross-clamping. Cardiac arrest in on-pump CABG induces global ischemia and reperfusion injury to the cardiac muscle. Besides, the Off-pump CABG provides a conspicuous survival advantage compared to the on-pump CABG, in association with a notable reduction in postoperative morbidity and mortality.

Pressure sore is an important post-stroke complication that results in increased morbidity, mortality and poor prognosis of the patients. The objective of the present study was to find out the prevalence and the factors associated with pressure sore among stroke patients. This prospective cross-sectional study includes 50 stroke patients admitted in the Department of Neurology of Dhaka Medical College Hospital, Bangladesh from July to December 2018. Data were collected from the by direct interview of the patients or their relatives or caregiver using a structured case report form. Descriptive statistics were used to represent patients' characteristics and the chi-square test was used to determine the difference between patients' groups. The mean ±SD age of the stroke patients was 59.16±11.53 years and half of them were male. Fifty percent of the patients had been suffering from ischemic stroke and the rest from hemorrhagic stroke. Of all, one-fourth of the patients (24.0%) developed post-stroke pressure sore during the hospital stay and type-specific prevalence was 20.0% in ischemic stroke and 30.0% in hemorrhagic stroke. Common sites of the pressure sore were sacrum (50.0%), buttock (25.0%), heels (17.0%), and greater trochanter (8.0%). Only 8.0% of the patients developed grade IV wounds. Pressure sores of 42.0% of patients healed spontaneously, 25.0% needed conservative management and 25.0% needed a skin graft. This study found that a large portion of stroke patients develop a pressure sore during hospital stay which can deteriorate clinical outcomes and compromise the quality of life of the patients. Adequate preventive measures and proper rehabilitation should be encouraged for better stroke management and to reduce long-term complications.

Chronic non-healing ulcers present significant challenges in diabetic, dermatological and surgical patients. Platelet-Rich Plasma (PRP), enriched with bioactive factors, offers promise for wound healing enhancement. The prospective observational study was done in the Department of Transfusion Medicine at AIIMS Bhopal for a period of two years, from April 2020 to 2022. This study evaluates PRP's efficacy, prepared via the single spin method, in non healing chronic ulcers. Aseptically, 100 ml of blood was drawn into CPDA (citrate-phosphate-dextrose-adenine) bags. PRP was prepared by centrifuging blood at 3400 rpm for 10 minutes, yielding PRP and buffy coat. Patient serum and 10.0% calcium gluconate were added to fibrin gel. PRP was injected around the ulcer and then dressed. Dressings were changed on the 5th, 15th and 20th days with PRP. The evaluation was done on day 30 using surface area and volume assessments. Thirteen patients aged 18-65 participated. The patients treated with single spin PRP (four females, nine males) had mean hemoglobin of 10.79±2.22gm/dL. Initial lesions (14.72cm²) significantly reduced to (8.78cm²) after application of single Spin PRP sessions (p=0.005). The PRP showed a mean platelet count of 1,527.00±192.26 × 10⁹/L. Ulcer surface area decreased from 9.87cm² to 7.56cm²; lesion volume reduced from 14.72cm³ to 8.78cm³. Platelet count differences between whole blood and PRP were significant (p<0.05). The single-spin PRP method exhibited considerable improvements in healing parameters, showcasing its potential for chronic ulcer management.

Stroke is one of the most common neurological disorder and third most common cause of death in the world. Low vitamin D concentrations have been shown to predict risk of cardiovascular disease and all-cause of mortality. The aim of this study was to estimate serum vitamin D level in acute ischemic stroke patients. This comparative cross-sectional type of study was conducted in the Department of Neurology and Department of Medicine at Mymensingh Medical College and Hospital, Bangladesh from November 2017 to June 2019 with a total number of 100 study subjects. Total fifty patients with acute ischemic stroke were enrolled in Group A and another fifty age and sex matched volunteer subjects were enrolled in Group B with no prior history of stroke or transient ischemic attacks. Serum vitamin D levels, fasting plasma glucose and lipid profile were assessed in both groups and compared with each other. P value <0.05 was considered as significant in the study. Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting triglycerides, serum fasting Low density lipoprotein (LDL) were significantly higher in Group A than Group B (p<0.05). Serum vitamin D level in Group A was 25.28±8.47ng/ml and in Group B was 30.90±5.80, (p=0.001). Insufficient vitamin D level was found in 52.0% of ischemic stroke patients and in 30% of healthy controls (p=0.0002). Vitamin D deficiency was found in 20.0% ischemic stroke patients and 10.0% in healthy controls. This study demonstrates a positive association between low serum vitamin D level and acute ischemic stroke. Further studies are required to determine whether vitamin D supplementation could improve functional outcome in patients with ischemic stroke.

Objective of the study was the effect of Covid-19 infection on pregnancy and neonatal outcomes. This prospective cohort study was conducted in Combined Military Hospital (CMH) Bogura, Obstetrics and Gynaecology department from June 2020 to October 2020. We have collected and analyzed data of 29 pregnant ladies positive for Covid-19. Control group was Covid-19 negative pregnant patients. Nasopharyngeal swab was taken for real time polymerase chain reaction for detection of Covid-19. We observed symptoms, compared any complication in mother and fetus, mode of termination, and duration of hospital stay. Only six patients were asymptomatic (10.3%). Fifteen (25.9%) had fever, six (6) had weakness (10.3%), 5(8.6%) had sore throat, 3(5.2%) had nausea and 5(8.6%) presented with loss of smell. Among twenty-nine patients, 5(8.6%) delivered normally, 24(41.4%) were delivered through caesarean section which was significantly higher than control group (p value <0.001). No mother became critical or expired, neonatal death was also absent. Mean duration of hospital stay was 14.13±6.192 days in case and 5.18±4.99 in control which was significantly (p value <0.001) higher. Breast feeding was significantly higher in control group (p value <0.001). This study shows feto-maternal outcome of Covid-19 pregnancy is almost same as those of normal pregnancy.

Vertebral and Hip fractures are the commonly encountered in low bone mass condition termed as osteoporosis. Bone mass and structure also affected by hypertension leading to increased susceptibility to fractures. This comparative cross-sectional study was conducted at two tertiary care centers in Dhaka metropolis from 1st January 2017 to 31st December 2017 under the department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM) to assess whether HTN is linked with higher OP fracture risk. In this study 54 hypertensive and 34 non-hypertensive osteoporotic female patients were involved. After face to face interview data were collected by using semi-structured questionnaire and checklist. Online assessment of fracture risk probability was done among the two groups by Fracture Risk Assessment Tool (FRAX) and statistical analysis was performed by Statistical Packages for Social Sciences (SPSS-23.0). In this study it is found that the mean ages were 61.94±9.362 years and 59.18±11.269 years for hypertensive and non-hypertensive patients respectively. Most of the patients with hypertensive (96.3%) and non-hypertensive (82.4%) were housewives. Mean duration of hypertension in osteoporotic women was 6.41±4.049 years while mean duration of osteoporosis was 8.80±5.022 years and 7.53±5.920 years in hypertensive and non-hypertensive patients respectively. The difference in risk of major osteoporotic fractures (MOF) by age was significantly (Χ², p<0.05) higher among patients aged 60-79 years and remarkably higher in hypertensive patients. In hypertensive patients though the risk of MOF by hypertension was relatively higher but it was not significant statistically (Χ², p>0.05). However the risk of hip fracture (HF) by hypertension was relatively higher among hypertensive patients and it was significant statistically (Χ², p<0.05). This reflects that the risk of hip fracture is higher significantly in hypertensive patients.

Metabolic Syndrome (METS) plays a pivotal role in the development of diabetes mellitus, coronary artery diseases and stroke. Due to the scarcity of data in this issue, this study aims to assess the frequency and risk factors association of METS among the hypertensive patients. This cross-sectional study recruited 667 eligible hypertensive patients aged between 20 and 70 years using non-probability purposive sampling method conducted from 1st January 2019 to 30th June 2019. Hypertensive patients with the known history of diabetes, thyroid, renal, cardiac, or hepatic disease, Cushing syndrome or malignancy and secondary causes of obesity, confirmed pregnancy, bed ridden, taking lipid lowering drugs or drugs that affect lipid and glucose metabolism were excluded from the study. METS among the hypertensive patients (DE novo or established hypertensive patients) of this study was demonstrated by NCEP-ATPIII (National Cholesterol Education Program-Adult Treatment Panel III) criteria having two or more of the following points [a) increased waist circumference ≥102cm in men and ≥88cm in women, b) hypertriglyceridemia: ≥150mg/dl, c) reduced High density lipoprotein cholesterol (HDL-C) <40mg/dL (1.04mmol/L) in men and <50mg/dL (1.29mmol/L) in women, d) high fasting blood glucose: 110mg/dl]. Significantly high frequency (69.9%, p<0.001) of METS was found with a significant female preponderance (52.5%, p<0.001) where the mean age of the study population was 48±11 years. Sex (p<0.001), education (p=0.041), occupation (p<0.001), Body mass index (BMI) (p<0.001) and hypertensive status (p=0.002) showed a highly significant role in the development of METS. Following binary logistic regression analysis after adjusting for confounders, the female sex was 17 times higher than the male [Adjusted odd ratio (AOR) =16.96, 95% CI=4.91-58.66, p<0.001)], obesity 4 times higher than non-obese [BMI (obese AOR=4.24, 95% CI=2.55-7.98, p<0.001)], hypertensive status [established hypertension two times higher than de novo (de-novo AOR=0.60, 95% CI=0.037-0.97, p=0.037)] were significant and independent predictors of METS. Significantly high BMI (27.7±4.2 and p<0.001), high waist circumference (60.4%, p<0.001) and hyper tri-glyceridaemia and reduced HDL (46.0%, p<0.001 and 51.3%, p<0.001) were found in the subjects with METS. In conclusion, high frequency of METS among the hypertensive patients was found in Jashore, Bangladesh with significant risk factors related to female sex, education, occupation, BMI and hypertensive status. So, a holistic evaluation of metabolic components among the hypertensive patients may reduce premature cardiovascular morbidity and mortality.

Obesity and hypothyroidism are interlinked. In this prospective study, 142 children and adolescents (mean age 140±34 months, girls 54.2%) either with obesity or overweight were included from the patients attending at the Endocrine out-patient clinic of Dhaka Shishu (Children) Hospital during a period from March, 2017 to February, 2020 and were assessed for thyroid function. Among them, 85 were obese (Body mass index, BMI >95th percentile), 29 were overweight (BMI between 85th to 95th percentile) and 28 had normal weight (BMI <85th percentile). Girls were more frequent in obese (57.6%) and overweight (51.7%) groups than boys. Mean TSH was not significantly different among the three groups (3.39 vs. 4.01 vs. 4.06mIU/L; p=0.248). Subclinical hypothyroidism was present in 22 cases (15.5%); the frequencies were 3.6% in Group 1, 17.2% in Group 2 and 18.8% in Group 3. Both overweight and obese groups had significantly (p<0.005) higher prevalence of SCH than the normal-weight group. Girls were more frequently affected than boys (72.7% vs. 27.3%, p=0.047). Among the 22 children who had SCH, 2(9.1%) had a mild goiter and higher serum levels of anti-TPO and anti-TG. Serum TSH had no correlations with age, body weight, height, BMI and serum FT₄. The findings indicate that a substantial portion of over weight and obese children and adolescents have SCH and the causes other than thyroid autoimmunity are more prevalent in them.

Multiple myeloma (MM), mature B-cell lineage neoplasm, is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein (M protein). The study was conducted to reveal presenting features, laboratory findings, Eastern Cooperative Oncology Group (ECOG) performance status and skeletal survey on patients with multiple myeloma. This descriptive, cross-sectional study was carried out in the Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 with a sample size of 81. Data were collected in a case record form after obtaining informed verbal consent from patients and /or their legal guardians. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with SPSS, Version 25.0 with presentation in figures and tables with frequency, percentage, mean and standard deviation based on data nature. Statistical tests were carried out as appropriate with 5.0% level of significance for assessing statistical association. Mean age of the patients was 58.9±12.0 years. Male female ratio was 2:1. 35(43.2%) patients were smokers with only 2(2.5%) had family history of haematological malignancies. Bone pain (72.8%) was the most common presenting feature, while hypertension (59.1%), diabetes mellitus (29.5%), respiratory illness (11.3%) and cardiac disease (11.4%) were the common co-morbidities. Most common ECOG performance status was ECOG-1(48.1%). Mean haemoglobin (Hb) was 9.4±2.3gm/dl and mean erythrocyte sedimentation rate (ESR) was 89.5±42.1 mm in 1st hour. Mean serum creatinine level was 2.0±1.85 mg/dl and ≥2.0mg/dl in 42(34.2%). Among 50 documentation serum lactate dehydrogenase (LDH) was raised in 18(36.0%). Mean serum calcium level was 9.6±1.8mg/dl >11.0mg/dL in 10(14.5%) cases. Serum albumin <3.5gm/dl in 37(49.3%), β2-microglobulin >5.5mg/dl in 37(57.8%) cases, International staging system (ISS) stage III was in 59.4% and Bence Jones Protein (BJP) was present in 46.7% cases. Lytic lesions were present in 75.0%, In 38(74.5%) patients vertebrae were involved, while in 18(35.2%) ribs were involved, in 14(27.5%) patients skull was involved and in 3(5.9%) patients involved bones were femur, humerus, sternum and scapula. Mean plasma cells percentage was 62.1±24.9%. Immuno-Fixation Electrophoresis (IFE) revealed IgG (72.7%), IgA (18.2%), Free light chain (FLC) (9.1%). FLC ratio was ≥100 in 29.0% cases. Significant statistical association was observed between serum creatinine with Hb concentration (p<0.05), serum creatinine level with ISS staging (p<0.05) and serum calcium level (p<0/05), while insignificant association was revealed between BJP present status and serum creatinine level (p>0.05). Bone pain, fatigue, fever and neurological impairment were the common presenting features. Anaemia, renal impairment and skeletal lytic events were the prominent physical findings. ISS staging was statistically associated with serum creatinine level, while serum calcium level was associated with serum creatinine and lytic lesions.

Recent advancement in surgical treatment of haemorrhoidal disease is not accessible by low socio-economic group of patient in a peripheral hospital of an underdeveloped country, where we aimed to evaluate the outcome of conventional surgeries. This descriptive, prospective, observational study was performed from diagnosis of haemorrhoidal disease to surgical intervention and followed up 12 months post operatively. Clinico-pathological data and outcome in the form of complications and recurrence within follow-up period was studied. Total 64 adult patients with mean age 38.6 years and male female ratio 1.7:1 were included in this study. Mean duration of symptoms was 13 months, reflects late presentation. Two (2) piles mass was seen most frequent in 36(56.3%) cases and most of the patients i.e. 44(68.8%) had haemorrhoids only on primary sites (3, 7 and 11 o'clock) of anal canal, but 18(28.1%) had mixed primary and secondary position of haemorrhoids. Similarly among those who had more than one haemorrhoid, grade 4 was commonest 35(53.1%) followed by only grade 3 in 15(23.4%) cases but mixed grade 3 and 4 was seen in 10(15.6%) patient. Complication less recovery was seen in 56(87.5%) cases, where delayed wound healing and pain was reported in 2(3.6%) patient each, followed by 1(1.6%) each reported urinary retention, anal sepsis, primary bleeding and reactionary bleeding. Mean hospital stay was 4 days. Conventional surgeries are equally efficacious and cost effective option for management of operable haemorrhoidal disease at any setup.

Clustering of hypertension, dyslipidemia, and other metabolic abnormalities is increasing the burden of non-communicable diseases, especially cardiovascular disease. The objective of this study was to explore the pattern of lipid profiles in newly diagnosed hypertensive patients attending Shaheed Mansur Ali Medical College, Dhaka, Bangladesh from August 2020 to December 2020. A total of 59 newly diagnosed hypertensive patients were studied through a cross-sectional approach. Prior to the study, ethical clearance was ensured, and informed written consent was obtained. A pre-structured questionnaire was used for data collection. Collected data were analyzed using SPSS 24.0 version. Slight male preponderance (54.2%) was observed along with an average age of 45 years among studied patients. Raised levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) were observed in 91.5%, 98.3%, and 88.1% of patients accordingly. Low level of high-density lipoprotein (HDL) was observed in 47.5% of the patients. Mean TC, TG, LDL, HDL were 286.11±347.37, 311.74±122.76, 163.27±33.67 and 38.29±6.66 mg/dl, respectively. Almost all patients were obese. There is no correlation between the serum lipid profile and blood pressure of the patients. Dyslipidemia was highly prevalent among newly diagnosed hypertensive patients.

This was a multicenter cohort study to evaluate the relationship between radiological findings and disability in moderate and severe head injury patients. The study places were the Neurosurgery department of Sylhet M A G Osmani Medical College Hospital, Sylhet Women's Medical College Hospital (SWMCH) and King Faisal Hospital (KFH), Taif, KSA. Sample size was 104 and the study period was 36 months (July 2021 to December 2022). On the basis of radiological findings the participants were divided into three arms. The different arms were diffused traumatic brain injury (arm-1), focal traumatic brain injury (arm-2) and both (diffused and traumatic) types traumatic brain injury (arm-3). Outcome was assessed by modified Rankin Score (mRS). Mean age was significantly higher in female. Overall mean age was 40.28 year. Highest number was in the below 20-year age group followed by the 41-50-year age group. Lowest number of participants was in the above 60-year group. Improved group was significantly higher than 'not improved' and the 'died' group (p<0.00001). Improved participants were significantly higher in the arm-1 and arm-2. Mortality was significantly higher (p<0.00001) in the arm-3 group.

Both of neurological emergencies and hyperglycemia are independently associated risk factors of mortality in the ICU patients. In critically ills, hyperglycemia is secondary to already existing DM or stress-induced hyperglycemia (SIH). Admission glycemic gap (AGG) is considered as a reliable indicator of SIH. This study aimed to explore the association of AGG on diabetic neuro-critical patients' short-term mortality, and understand the potential of AGG as the predictor of outcome. Sixty adult diabetic neuro-critical patients admitted in ICU and stayed at least for 24 hours, were prospectively observed for 30 days, or until discharge or death, whichever came first. The patients' initial clinical assessment and HbA1c, CBC, ABG, and blood glucose level were done within 24 hours of admission. A1c derived admission glucose (ADAG) was calculated as, ADAG = (1.59 × HbA1c) - 2.59 (mmol/L). The AGG was calculated by subtracting ADAG from admission blood glucose level (ABGL). Death or survival of 30 days was our primary outcome and participants were divided between survivor or non-survivor groups according to primary outcome. Statistical comparisons of the study variables between the groups were performed and the relationship between parameters derived from blood glucose and mortality was prospected. Among the 60 patients enrolled, 35(58.3%) were non-survivors and 25(41.7%) were survivors. Age, sex, residence, primary diagnosis, co-morbidity, or drug history had no association with survival/non-survival. Among the initial clinical assessment parameters, lower GCS had significant association with non-survival. AGG, HbA1c, ADAG and ABGL were significantly different between the groups, with higher values in the non-survivors. Lower GCS, and higher AGG, HbA1c, ADAG and ABGL showed significant odds of non-survival. The highest odds of non- survival was for AGG (OR 2.95, 95% CI: 1.83-4.75; p<0.001). For ABGL and HbA1c the OR were 2.03 (95% CI: 1.44-2.86; p<0.001) and 1.93 (95% CI: 1.04-3.58; p<0.04) respectively. The final adjusted odds (aOR) of non-survival for higher AGG was 3.25 (95% CI: 1.71-6.16; p<0.001), signifying that AGG is independently associated with non-survival. AGG, GCS level, ABGL, HbA1c level, and ADAG can predict short-term outcome (mortality). However, AGG has the greatest potential to predict short-term outcome in diabetic neuro-critical patients.

Obesity is associated with metabolic disorders such as dyslipidaemia, diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD). There has been rising burden of childhood and adolescent obesity in most developing countries in recent years. Changes in dietary habits, junk and fast food, physical inactivity and smoking habits increases among adolescent students, which causes obesity and simultaneously increases risk of metabolic diseases. The objective of the study is to determine the correlation between Body Mass Index (BMI) and lipid profile among adolescent students of Bangladesh. This cross-sectional observational study was conducted among 79 undergraduate healthy adolescent students, aged 10-18 years who were selected through purposive sampling. The study was conducted from July 2022 to June 2023 in urban and rural areas of Dhaka, Narayanganj and Rangpur. Data was collected using a semi-structured questionnaire. Correlation of dyslipidemia and BMI was analyzed by Pearson Coefficient. Data was analyzed using SPSS version 22.0 with level of statistical significance at p<0.05. Mean age of the respondents was 14.9±4.5 years. Male and female ratio was 2.16:1. Among respondents, 46.8% had BMI 18.5-23.0 (normal), 31.6% had BMI 23.1-25.0 (overweight) and 21.5% had BMI >25.0 (obese). Prevalence of dyslipidaemia was 34.1%. Overweight and obese respondents had raised total cholesterol (TC) level 209.51±48.6 mg/dl and 218.36±80.0 mg/dl respectively. Mean high density lipoprotein (HDL) cholesterol level was 38.91±10.51 mg/dl in overweight and 36.54±10.04 mg/dl in obese. Mean low density lipoprotein (LDL) cholesterol level was 135.23±44.5 mg/dl in overweight and 143.61±56.0 mg/dl in obese. Among obese cases, 94.1% respondents had borderline triglyceride (TG) with mean 164.46±111.0 mg/dl. Among the study respondents, overweight and obesity (higher BMI) tend to have abnormal lipid profile. It is recommended that assessment of BMI should be incorporated into school health programme and those with overweight and obesity should be subjected to routine lipogram in order to apply timely preventive as well as therapeutic measures to save lives.

In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how health care and prescription medication affordability changed among low-income adults during the COVID-19 pandemic overall and compared with their higher-income counterparts.

The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.

Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households.

Patients with myocardial ischemia without obstructive coronary artery disease often have coronary microvascular dysfunction (CMD) and associated increased risk of cardiovascular (CV) events and anginal hospitalizations. Epicardial adipose tissue (EAT) covers much of the myocardium and coronary arteries and when dysfunctional, secretes proinflammatory cytokines and is associated with CV events. While oxidative stress and systemic inflammation are associated with CMD, the relationship between EAT and CMD in women is not well known.

This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women.

Natural killer (NK) cells make only a small fraction of immune cells in the human body, however, play a pivotal role in the fight against cancer by the immune system. They are capable of eliminating abnormal cells via several direct or indirect cytotoxicity pathways in a self-regulating manner, which makes them a favorable choice as a cellular therapy against cancer. Additionally, allogeneic NK cells, unlike other lymphocytes, do not or only minimally cause graft-versus-host diseases opening the door for an off-the-shelf therapy. However, to date, the production of NK cells faces several difficulties, especially because the critical process parameters (CPPs) influencing the critical quality attributes (CQAs) are difficult to identify or correlate. There are numerous different cultivation platforms available, all with own characteristics, benefits and disadvantages that add further difficulty to define CPPs and relate them to CQAs. Our goal in this contribution was to summarize the current knowledge about NK cell expansion CPPs and CQAs, therefore we analyzed the available literature of both dynamic and static culture format experiments in a systematic manner. We present a list of the identified CQAs and CPPs and discuss the role of each CPP in the regulation of the CQAs. Furthermore, we could identify potential relationships between certain CPPs and CQAs. The findings based on this systematic literature research can be the foundation for meaningful experiments leading to better process understanding and eventually control.

The genomic landscape of clear cell renal cell carcinoma (ccRCC) has a considerable intra-tumor heterogeneity, which is a significant obstacle in the field of precision oncology and plays a pivotal role in metastasis, recurrence, and therapeutic resistance of cancer. The mechanisms of intra-tumor heterogeneity in ccRCC have yet to be fully established. We integrated single-cell RNA sequencing (scRNA-seq) and transposase-accessible chromatin sequencing (scATAC-seq) data from a single-cell multi-omics perspective. Based on consensus non-negative matrix factorization (cNMF) algorithm, functionally heterogeneous cancer cells were classified into metabolism, inflammatory, and EMT meta programs, with spatial transcriptomics sequencing (stRNA-seq) providing spatial information of such disparate meta programs of cancer cells. The bulk RNA sequencing (RNA-seq) data revealed high clinical prognostic values of functionally heterogeneous cancer cells of three meta programs, with transcription factor regulatory network and motif activities revealing the key transcription factors that regulate functionally heterogeneous ccRCC cells. The interactions between varying meta programs and other cell subpopulations in the microenvironment were investigated. Finally, we assessed the sensitivity of cancer cells of disparate meta programs to different anti-cancer agents. Our findings inform on the intra-tumor heterogeneity of ccRCC and its regulatory networks and offers new perspectives to facilitate the designs of rational therapeutic strategies.

One-third of people with HIV in sub-Saharan Africa start antiretroviral therapy (ART) with advanced disease. We investigated associations between immune biomarkers and mortality in participants with advanced HIV randomised to cotrimoxazole or enhanced antimicrobial prophylaxis in the Reduction of Early Mortality in HIV-Infected Adults and Children Starting Antiretroviral Therapy (REALITY) trial (ISRCTN43622374). Biomarkers were assayed using ELISA and Luminex. Associations between baseline values and all-cause 24-week mortality were analysed using Cox models, and for cause-specific mortality used Fine & Gray models, including prophylaxis randomisation, viral load, CD4, WHO stage, age, BMI, and site as covariates; and weighted according to inverse probability of selection into the substudy. Higher baseline CRP, IFN-γ, IL-6 and IP-10 were associated with higher all-cause mortality; and higher IL-23, IL-2 and RANTES with lower all-cause mortality. Associations varied by cause of death: tuberculosis-associated mortality was most strongly associated with higher CRP and sST2, and cryptococcosis-associated mortality with higher IL-4 and lower IL-8. Changes in I-FABP (p = 0.002), faecal alpha-1 antitrypsin (p = 0.01) and faecal myeloperoxidase (p = 0.005) between baseline and 4 weeks post-ART were greater in those receiving enhanced versus cotrimoxazole prophylaxis. Our findings highlight how the immune milieu shapes outcomes following ART initiation, and how adjunctive antimicrobials can modulate the gut environment in advanced HIV.

Transit bipartition (TB) emerges as a bariatric surgery alternative to Duodenal Switch (DS), emphasizing complete intestinal access and reduced malabsorption. By directly stimulating the distal ileum, TB promotes weight loss while preserving endoscopic duodenal access. This technique enhances anorexigenic hormones, aiding in satiety and weight loss, with lower malnutrition risks than DS. TB shows favorable short-term outcomes in weight management and comorbidity reduction, serving as a simpler, less malabsorptive option than DS. Nonetheless, long-term studies are essential for comprehensive efficacy assessment.

Personalised medicine is seen as an exciting opportunity to improve the health outcomes of people with obesity. As research on phenotyping and personalised treatment for obesity rapidly advances, this study sought to understand patient preferences and perspectives on personalised medicine for obesity.

Recent advancements in PET technology have culminated in the development of total-body PET (TB-PET) systems, which overcome many limitations of traditional scanners. These TB-PET scanners, while still becoming widely available, represent the forefront of clinical imaging across numerous medical institutions worldwide. Early clinical applications have demonstrated their enhanced image quality, precise lesion quantification, and overall superior performance relative to conventional scanners. The capabilities of TB-PET technology, including extended scan range, ultrahigh sensitivity, exceptional temporal resolution, and dynamic imaging, offer significant potential to tackle unresolved clinical challenges in medical imaging. In this discussion, we aim to explore the emerging applications, opportunities, and future perspectives of TB-PET/CT in musculoskeletal disorders (MSDs). Clinical applications for both oncologic and non-oncologic musculoskeletal diseases are discussed, including inflammatory arthritis, infections, osteoarthritis, osteoporosis, and skeletal muscle disorders. From the ability to visualize small musculoskeletal structures and the entire axial and appendicular skeleton, TB-PET shows significant potential in the diagnosis and management of MSD conditions as it becomes more widely available.

Choriocarcinoma is a highly malignant pregnancy-related trophoblastic neoplasm, characterized by early metastasis to the lungs. Therefore, patients may manifest nongynecological symptoms owing to distant metastases. The incidence of choriocarcinoma after a term pregnancy is really rare (1/160,000 pregnancies).

BACKGROUND Congenital hypoplasia of the thumb type IV, also known as floating thumb, is a condition in which 2 small phalanges are attached to the hand with a thin skin bridge. Surgical management options for this condition vary from amputation to flap reconstruction. MATERIAL AND METHODS This retrospective study analyzed 11 infants with congenital hypoplasia of the thumb type IV who underwent surgical reconstruction using a modified vascularized polydactylous hallux flap. The study included 6 male and 5 female infants, aged 6 to 24 months. Functional evaluations and radiographic studies were conducted postoperatively. RESULTS All 11 patients underwent the complete surgical protocol. Successful vascular and nerve anastomoses were performed during the initial procedure, ensuring sufficient blood supply and neural connectivity to the transferred toes. The second operation showed promising outcomes, including improvements in thumb opposition, grasp strength, and overall function. Postoperative assessments demonstrated satisfactory radiographic alignment and no major complications during the follow-up period. CONCLUSIONS The modified vascularized polydactylous hallux flap reconstruction is a viable surgical option for managing congenital hypoplasia of the thumb type IV in infants. This technique effectively restores thumb opposition, grasp strength, and overall hand function, with satisfactory radiographic alignment and minimal complications. The study findings support the efficacy and safety of this surgical approach in addressing this rare congenital anomaly.

For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity.

BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet activation, leading to thrombocytopenia and thromboembolism. Gustilo-Anderson type IIIC open fractures of the extremities are defined as open fractures presenting with arterial injuries that require repair and result in treatment challenges and complications. The diagnosis of HIT can be difficult in patients with severe trauma with consumptive thrombocytopenia associated with heavy bleeding and the use of heparin after vascular anastomosis. CASE REPORT A 48-year-old man was injured in a car accident, pinching his right lower leg and sustaining a Gustilo-Anderson type IIIc open fracture, for which he underwent emergency revascularization surgery. Heparin was administered continuously immediately after the surgery. On postoperative day 9, ischemic changes were observed in the right foot, and we performed suture re-anastomosis; however, the blood circulation in the right lower leg did not resume, and right lower leg amputation was performed due to ischemic necrosis with the onset of HIT. Postoperatively, the patient was switched to edoxaban after the recovery of his platelet count. Thereafter, the patient experienced no new thrombus occlusion or wound trouble, and was able to walk on a prosthetic leg and return to daily life. CONCLUSIONS It is important to consider the possibility of HIT as soon as thrombocytopenia appears in patients with Gustilo-Anderson type IIIC open fracture who are receiving heparin after vascular anastomosis, as a delayed diagnosis of HIT can make it difficult to save the limb.

Isocitrate dehydrogenase (IDH) and cyclin-dependent kinase inhibitor (CDKN) 2A/B status holds important prognostic value in diffuse gliomas. We aimed to construct prediction models using clinically available and reproducible characteristics for predicting IDH-mutant and CDKN2A/B homozygous deletion in adult-type diffuse glioma patients.

Gut metaproteomics can provide direct evidence of microbial functions actively expressed in the colonic environments, contributing to clarify the role of the gut microbiota in human physiology. In this study, we re-analyzed 10 fecal metaproteomics datasets of healthy individuals from different continents and countries, with the aim of identifying stable and variable gut microbial functions and defining the contribution of specific bacterial taxa to the main metabolic pathways. The "core" metaproteome included 182 microbial functions and 83 pathways that were identified in all individuals analyzed. Several enzymes involved in glucose and pyruvate metabolism, along with glutamate dehydrogenase, acetate kinase, elongation factors G and Tu and DnaK, were the proteins with the lowest abundance variability in the cohorts under study. On the contrary, proteins involved in chemotaxis, response to stress and cell adhesion were among the most variable functions. Random-effect meta-analysis of correlation trends between taxa, functions and pathways revealed key ecological and molecular associations within the gut microbiota. The contribution of specific bacterial taxa to the main biological processes was also investigated, finding that Faecalibacterium is the most stable genus and the top contributor to anti-inflammatory butyrate production in the healthy gut microbiota. Active production of other mucosal immunomodulators facilitating host tolerance was observed, including Roseburia flagellin and lipopolysaccharide biosynthetic enzymes expressed by members of Bacteroidota. Our study provides a detailed picture of the healthy human gut microbiota, contributing to unveil its functional mechanisms and its relationship with nutrition, immunity, and environmental stressors.

Penile cancer (PeCa) is a rare disease. HPV infection, smoking, phimosis, and lichen sclerosus represent well-known associated risk factors.

Infectious bursal disease virus (IBDV) is an acute and highly infectious RNA virus known for its immunosuppressive capabilities, chiefly inflicting rapid damage to the bursa of Fabricius (BF) of chickens. Current clinical control of IBDV infection relies on vaccination. However, the emergence of novel variant IBDV (nVarIBDV) has posed a threat to the poultry industry across the globe, underscoring the great demand for innovative and effective vaccines. Our previous studies have highlighted the critical role of IBDV VP5 as an apoptosis-inducer in host cells. In this study, we engineered IBDV mutants via a reverse genetic system to introduce amino acid mutations in VP5. We found that the mutant IBDV-VP5/3m strain caused reduced host cell mortality, and that strategic mutations in VP5 reduced IBDV replication early after infection, thereby delaying cell death. Furthermore, inoculation of chickens with IBDV-VP5/3m effectively reduced damage to BF and induced neutralizing antibody production comparable to that of parental IBDV WT strain. Importantly, vaccination with IBDV-VP5/3m protected chickens against challenges with nVarIBDV, an emerging IBDV variant strain in China, reducing nVarIBDV loads in BF while alleviating bursal atrophy and splenomegaly, suggesting that IBDV-VP5/3m might serve as a novel vaccine candidate that could be further developed as an effective vaccine for clinical control of IBD. This study provides a new clue to the development of novel and effective vaccines.

Suspected allergic reactions after mRNA COVID-19 vaccination withheld multiple individuals from getting fully vaccinated during the pandemic. We vaccinated adults who had experienced possible allergic symptoms after their first intramuscular dose of a COVID-19 mRNA vaccine with a 1/5th fractional intradermal test dose of the mRNA-1273 (Moderna) COVID-19 vaccine. No anaphylactic reactions were observed after intradermal vaccination (n = 56). Serum anti-S1 IgG concentrations were measured using a bead-based multiplex assay four weeks after vaccinations. Antibody concentrations were compared with a previously collected nationwide cohort that had received two intramuscular doses of mRNA-1273. Antibody responses in all subjects tested (n = 47) were comparable to standard of care intramuscular dosing. Fractional intradermal dosing of mRNA COVID-19 vaccines may provide a pragmatic solution that is safe, time efficient compared to skin prick testing, dose sparing and immunogenic in individuals with suspected vaccine allergy.

Immune response to COVID-19 vaccine is diminished in patients with hematologic malignancy. There is limited data regarding response to vaccine doses in these patients.

Maternal immunisation is a powerful tool to protect both pregnant women and their children. A new maternal RSV vaccine holds promise to protect newborns from RSV-associated illness in the first few months of life, but no official recommendation has been made in Germany. Since RSV causes a significant burden of paediatric hospital admissions, we consider it a pertinent opportunity to review barriers to maternal vaccination in Germany, which might also apply to other settings. Access to vaccination for pregnant women in Germany is shaped by an interplay of legal, regulatory, institutional, and sociocultural factors, with a less permissive clinical research environment, delays in recommendation and roll-out, and lower acceptance by healthcare professionals and the population. Actionable recommendations to improve availability and uptake include coordination with other national regulatory bodies to reduce delays, awareness and literacy campaigns for health professionals and the general public, and capacity building for vaccine clinical research.

An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy.

There has been tremendous effort to improve quality following colorectal surgery, including the proliferation of minimally invasive techniques, enhanced recovery protocols, and surgical site infection prevention bundles. While these programs have demonstrated improved postoperative outcomes at the institutional level, it is unclear whether similar benefits are present on a national scale.

Large, multinucleated cells, like syncytiotrophoblasts (STB), are not readily analyzed by standard methods used for single cells, such as single-cell RNA-sequencing and fluorescence-activated cellular sorting (FACS). Here we have demonstrated that fluorescence-activated nuclear sorting (FANS) is suitable to analyze nuclei from STB. Human pluripotent stem cells (PSCs) can be differentiated into a mixed trophoblast populations comprising approximately 20 % STB by treatment with BMP4 (Bone Morphogenetic Protein-4), plus A83-01 and PD173074, inhibitors of activin and FGF2 signaling, respectively (the BAP model) in about a week. Here we demonstrate that FANS can be used to separate two types of STB nuclei from the nine different clusters of trophoblast nuclei previously identified in the BAP model by single nucleus RNA sequencing (snRNAseq). Rather than using cell surface markers, as in FACS, transcription factors in various combinations were employed to target specific nuclear types. Nuclei were isolated at d 8 of BAP differentiation of H1 human embryonic stem cells and fixed in 4 % paraformaldehyde. After permeabilization in 0.1 % triton X-100, nuclei were incubated for 3 and 1 h at 4 °C with primary and secondary antibodies respectively and nuclear samples were then subjected to FANS. By using markers identified by snRNA and immunohistochemistry, nuclei were first sorted into a Topoisomerase-1, or TOP1, bright population and then into the two STB subpopulations by using antibodies to JUNB (Jun B Proto-Oncogene) and TFCP2L1 (Transcription Factor CP2 Like 1). The protocol established here is simple, straightforward, and efficient and can be used on a relatively large scale to sort individual subtypes of nuclei from mixed populations of trophoblasts for further analysis.

Pancreas segmentation accuracy at CT is critical for the identification of pancreatic pathologies and is essential for the development of imaging biomarkers. Our objective was to benchmark the performance of five high-performing pancreas segmentation models across multiple metrics stratified by scan and patient/pancreatic characteristics that may affect segmentation performance.

The widespread administration of COVID-19 vaccines has prompted a need to understand their safety profile. This investigation focuses on the safety of inactivated and mRNA-based COVID-19 vaccines, particularly concerning potential cardiovascular and haematological adverse events. A retrospective cohort study was conducted for 1.3 million individuals residing in Abu Dhabi, United Arab Emirates, who received 1.8 million doses of the inactivated BBIBP CorV (by SinoPharm) and mRNA-based BNT162b2 (Pfizer-BioNTech) vaccines between June 1, 2021, and June 30, 2022. The study's primary outcome was to assess the occurrence of selected cardiovascular and haematological events leading to hospitalization or emergency room visits within 21 days post-vaccination. Results showed no significant increase in the incidence rates of these events compared to the subsequent 22 to 42 days following vaccination. Analysis revealed no elevated risk for adverse outcomes following first (IRR 1·03; 95% CI 0·82-1·31), second (IRR 0·92; 95% CI 0·72-1·16) and third (IRR 0·82; 95% CI 0·66-1·00) doses of either vaccine. This study found no substantial link between receiving either mRNA and inactivated COVID-19 vaccines and a higher likelihood of cardiovascular or haematological events within 21 days after vaccination.

The replacement of the ABR in-person oral examination with the DR certifying examination affected approximately 15,000 radiologists, spanning from 2013 to 2027. This decision was motivated by better aligning with the timing of other American Board of Medical Specialty (ABMS) members, more closely reflecting real-world practice of radiology and narrowing training geared towards the trainee's subspecialty preference. However, in retrospect, this change may have subtracted from the quality and value of diagnostic radiology training as a whole with the de-emphasis on competence in general radiology, communication skills, and cognitive reasoning. In this paper, the authors lay out a blueprint necessary in order to rewind the clock of how diagnostic radiology programs can prepare their trainees for the new DR oral examination. Such a change will require substantial redactions affecting all designations, including radiology faculty, education teams, departmental leadership, academic institutions, ACGME, and ABR. The authors believe that implementing these modifications will not only effectively equip radiology candidates for the new DR oral examination but will also augment the significance of radiologists as indispensable members of multidisciplinary teams. The authors also outline the challenges that could emerge from these changes and speculate on the anticipated role of AI in future oral board examinations.

Although extreme heat has been found to be disproportionately distributed with respect to socially disadvantaged and marginalized groups, persons with disabilities have received limited attention in previous research on heat exposure disparities.

This study investigates the potential applications of incorporating 2D bacterial cellulose microfibers (BCM) biochar into chitosan/polyethyleneimine beads as a semi-natural sorbent for the efficient removal of tetracycline (TET) and metronidazole (MET) antibiotics. Batch adsorption experiments and characterization techniques evaluate removal performance and synthesized adsorbent properties. The adsorbent eliminated 99.13 % and 90 % of TET and MET at a 10 mg.L concentration with optimal pH values of 8 and 6, respectively, for 90 min. Under optimum conditions and a 400 mg.L concentration, MET and TET have possessed the maximum adsorption capacities of 691.325 and 960.778 mg.g, respectively. According to the isothermal analysis, the adsorption of TET fundamentally follows the Temkin (R = 0.997), Redlich-Peterson (R = 0.996), and Langmuir (R = 0.996) models. In contrast, the MET adsorption can be described by the Langmuir (R = 0.997), and Toth (R = 0.991) models. The pseudo-second-order (R = 0.998, 0.992) and Avrami (R = 0.999, 0.999) kinetic models were well-fitted with the kinetic results for MET and TET respectively. Diffusion models recommend that pore, liquid-film, and intraparticle diffusion govern the rate of the adsorption process. The developed semi-natural sorbent demonstrated exceptional adsorption capacity over eleven cycles due to its porous bead structure, making it a potential candidate for wastewater remediation.

The issue of obstetric violence is internationally acknowledged as a serious violation of human rights. First identified by the Committee of Experts of the Inter-American Belém do Pará Convention in 2012, it is recognized as a form of gender-based violence that infringes upon women's rights during childbirth. Nations such as Argentina, Mexico, Venezuela, and certain regions in Spain have implemented laws against it, highlighting its severity and the need for protective legislation. Major international organizations, including WHO and the Council of Europe, advocate for the elimination of disrespectful and abusive treatment in maternity care. In 2019, the UN Special Rapporteur on violence against women called on states to protect women's human rights in reproductive services by enforcing laws, prosecuting perpetrators, and providing compensation to victims. However, despite advances, there remains institutional and systemic resistance to recognizing obstetric violence, which undermines trust in healthcare and impacts women's quality of life. Addressing this violence is imperative, requiring education and training in women's human rights for all healthcare professionals. As part of the coalition of experts from various organizations (InterOVO), we respond to the publication by EAPM, EBCOG, and EMA: "Joint Position Statement: Substandard and Disrespectful Care in Labor - Because Words Matter." We are committed to preventing and mitigating obstetric violence and improving care for women and newborns.

Guideline adherence in radiotherapy is crucial for maintaining treatment quality and consistency, particularly in non-trial patient settings where most treatments occur. The study aimed to assess the impact of guideline changes on treatment planning practices and compare manual registry data accuracy with treatment planning data.

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

A study was conducted to investigate the associations of the diseases of the organ of vision and its accessory apparatus with anxiety and depression in the elderly people. The study included 678 participants of the ESSE-RF3 population study in the Arkhangelsk region in the age of 60-74 years. We used a questionnaire, including the hospital scale of anxiety and depression score (HADS), and the assessment of the ophthalmological status. It was found that all the study participants had diseases of the visual organ. Elevated depression scores were associated with sex, age, marital status (being single), and disability, elevated anxiety scores - with sex. The scores on the anxiety scale were on average 25% higher in participants whose visual acuity decreased to 0,5 units, and showed no independent associations with diagnosed ophthalmological diseases. The scores on the depression scale were on average 33% higher in participants with visual acuity 0,5 units, and 22% higher in the presence of retinopathy. In conclusion, anxiety and depression in the elderly people were more associated with visual deficits rather than with the presence of ophthalmological diseases underlying a decrease in functional status.

The significant prevalence of periodontal diseases in elderly patients makes the research relevant. By now, the issues of complex clinical and radiological semiotics of generalized periodontitis using high-tech research methods is not sufficiently studied. The research addressed the clinical picture and three-dimensional computed tomographic semiotics of severe chronic generalized periodontitis focusing 25 elderly patients with severe chronic generalized periodontitis. It verified the necessity to use an organ-oriented program of multiplanar (volumetric) cone-beam computed tomography coupled with the analysis of the research results, as well as a mandatory analysis of densitometry indicators of the jaw bone tissue in diagnostically significant periodontal zones.

A review of the use of comprehensive geriatric assessment and its components in oncology is introduced. The evidence base for the increasing incidence of cancer in the elderly worldwide also presented. The management of older adults with cancer is challenging. Comprehensive Geriatric Assessment (CGA) has been shown by many authors to be a strong predictor of adverse events in geriatric oncology patients. CGA is recommended in oncology practice for many reasons: to identify health problems not usually detected in routine oncologic screening, to perform non-oncologic interventions, and to modify the cancer treatment plan. Comprehensive geriatric assessment is the gold standard in geriatric oncology for identifying patients at high risk for adverse outcomes and optimizing cancer treatment and overall management. Nevertheless, it can be stated that the final point in the search for evidence-based and effective frailty assessment tools in the practice of geriatric oncology has not yet been reached. It is concluded that the development of new scales and index scores, as well as the application of the CGA model in general, can provide adequate care for elderly cancer patients.

This review presents data from the literature on the characteristics of the course of chronic kidney disease from the perspective of the geriatric patient. Chronic kidney disease and progression of renal failure is a prototype model of premature and accelerated aging. Many authors have stated that a better mechanistic understanding of the phenomenon of premature aging, early diagnosis of chronic kidney disease, and a geriatric approach to the patient can improve the effectiveness of management and prolongation of life in this category of patients. Comprehensive geriatric assessment is one of the most important tools used by geriatricians and their teams to globally assess elderly patients and plan effective interventions. It is concluded that the use of comprehensive geriatric assessment in patients with chronic kidney disease may improve the clinical status of patients and allow selection of patients who may benefit most from renal replacement therapy compared to a conservative approach. And even in the early stages of chronic kidney disease, a comprehensive geriatric assessment may be useful in formulating a complete intervention plan and optimizing quality of life, autonomy, and prognosis. However, despite recognition of the importance of comprehensive geriatric assessment, the means to implement this tool in nephrology departments have not been developed and require special training programs and appropriate skills. It is concluded that much more needs to be done to realize the continuity of nephrologists and geriatricians in the provision of meaningful skilled care to older patients with chronic kidney disease.

After cholecystectomy, elderly patients require special attention, due to the influence of involution processes in the body on the formation of complications. To identify prognostic criteria for the formation of fatty liver degeneration in the long-term period of minimally invasive cholecystectomy, 159 men were examined. Dysregulation of the biliary tract was determined using magnetic resonance cholangiopancreatography, elastography and magnetic resonance imaging of the liver. Microbial markers of the wall microbiome of the intestine were determined using chromatography-mass spectrometry. The relationship between an increase in body mass index and a decrease in the amount of obligate microbiome (r=-0,43, p<0,050), as well as with the formation of fatty liver degeneration in elderly patients, was revealed. The features of vegetative regulation in elderly people with fatty liver degeneration have been determined. It has been proven that in old age, a decrease in the number of obligate anaerobic association of microorganisms of the small intestine (on average from 15 659 to 7 630 in persons of the 2nd age subgroup and from 1 457 to 17 837 in the 3rd) is a predictor of fatty liver degeneration. The prognostic algorithm developed on the basis of the analysis of highly informative signs makes it possible to identify with an accuracy of at least 75% a high risk of fatty liver degeneration in the long-term period of cholecystectomy.

Understanding the recovery process of functional abilities post-COVID-19 in older inpatients with arterial hypertension and ischemic heart disease is important for optimising healthcare delivery and resources. Participants in this study were individuals undergoing hospital-based rehabilitation following COVID-19 (average age 66, n=183). They were categorised into groups with arterial hypertension (n=92), ischemic heart disease (n=18), both conditions (n=38), and a control group without these diseases (n=35). Functional abilities were assessed via the distance walked until signs of exhaustion (meters), handgrip strength (kilograms), and breath-holding time (seconds). Multiple regression analysis revealed that inpatients with arterial hypertension walked shorter distances (β=-19,183; p=0,050) but showed higher handgrip strength (β=3,735; p=0,025) compared to the control group. Post-rehabilitation, inpatients with hypertension demonstrated greater performance (β=40,435, p=0,024) and better improvement rates (β=47,337; p=0,016) in walked distance than those in the control group. Significant interaction effects between groups and pre-/post-rehabilitation changes were observed only for walking distance (β=34,74; p=0,02), with no significant interactions found for other measures. The findings indicate that older inpatients with arterial hypertension may experience comparable or enhanced recovery of functional abilities post-COVID-19. The presence of ischemic heart disease, alone or combined with hypertension, does not significantly impair rehabilitation outcomes compared to those without such conditions.

Communication is considered as one of the basic human needs. For a long time, loneliness and social isolation were mainly considered as a psychosocial problem. However, in the recent years, there has been increasing evidence of the possible impact of loneliness and social isolation on the development and clinical course of somatic diseases. Research objectives were studying and analysis of current literature data about the medical consequences of loneliness and social isolation in the elderly cases. An analysis of the literature data shows that loneliness and social isolation affect not only the psycho-emotional status of elderly patients, but also their physical health. It has been shown that the number of available social connections affects the development and clinical course of diabetes mellitus, cardiovascular diseases, and outcomes of the brain stroke, immune system reactions, average life expectancy, and the risk of death caused by any causes. It has been established that the influence of social ties on the risk and clinical course of chronic non-communicable diseases is comparable to the effect of such generally accepted risk factors like smoking, alcohol consumption, physical inactivity, hypertension, obesity, hypercholesterolemia, environmental pollution, as well as various medical interventions (vaccination, drug therapy, etc.). Social isolation affects the risk of hospitalization and the frequency of outpatient care, poor socialization increases the risk of death from a heart attack. The results of the study show that loneliness and social isolation of the elderly cases have certain medical consequences that need to be taken into account when managing such patients.

Metabolic syndrome is a group of disorders that are closely related to both the risk of developing type 2 diabetes mellitus and cardiovascular diseases, and generally leading to the phenomenon of premature aging of the body. Excessive accumulation of adipose tissue contributes to the development of chronic immune inflammation and oxidative stress, which are both precursors to various disorders, such as insulin resistance, arterial hypertension and dyslipidemia, but also trigger inflammatory processes in patients. An increasing number of studies support the importance of chronic immune inflammation in the pathogenesis of metabolic syndrome, as pro-inflammatory markers such as TNF-α, IL-1β, IL-6, monocyte chemotactic protein-1 and growth of vascular endothelium. Among a wide range of cytokines, monocyte chemotactic protein-1 is considered one of the most important chemokines, which activates monocytes and other immune cells actively involved in inflammation. Another important point of chronic immune inflammation is its impact on the mental health of patients with metabolic syndrome. Increased levels of anxiety and depression are associated with levels of pro-inflammatory cytokines produced by adipose tissue, which ultimately has an adverse effect on the cognitive status of patients.

Research on the condition of the lungs in senile people is an urgent task. This is due to the fact that degenerative or age-associated changes in the respiratory system play an important role in the formation of senile asthenia syndrome and a decrease in the age-related viability of the body as a whole. CT-scans of patients aged 80-90 years were analyzed (n=31). Age-associated changes were evaluated: the presence of linear fibrosis, increased pulmonary pattern by the type of reticular (reticular) changes, the presence of gross fibrous reticular changes with cystic cavities and air bullae (by the type of «cellular lung»), as well as the presence of pulmonary emphysema. Most naturally, senile people show changes characteristic of linear pulmonary fibrosis and emphysema. The progression of the process leads to diffuse reticular changes in the interalveolar and intersegmental septa and, in adverse cases, to the formation of gross changes in the type of «cellular lung». Fibro-emphysematous changes are significantly more common in men. A microbiological study of the microbiota of the lower respiratory tract in elderly people was also carried out (n=16). When studying the microbiocenosis of the lower respiratory tract in elderly people, the following data were obtained: resident microflora was found in 71% and clinically significant microorganisms were found in 29%.

From the age of 25-30, the likelihood of developing pathological processes associated with aging begins to increase. Age-associated diseases (AAD) are a heterogeneous group of pathologies that are more likely to develop as they age. Clinically, the early development of AAD is identical to premature aging with all the ensuing consequences. Timely targeted detection of AAD will slow down age-related processes. In order to study the peculiarities of age-related morbidity (by circulation), age-associated pathology, the study included 5 600 people with a newly diagnosed diagnosis who applied to the municipal polyclinic of St. Petersburg in 2017-2023. During the study, heterogeneity of the timing of the manifestation of AAD at the population level was found. In addition, the median age of patients was comparable to the value of the developed age-specific incidence index, which serves as a basis for continuing research in order to comprehensively assess the properties and limitations of the considered indicator.

The purpose of the study was a comparative analysis the effectiveness of microsurgical discectomy and minimally invasive transforaminal lumbar interbody fusion in the treatment of disk herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients. The study included 80 elderly patients (over 60 years old), divided into two groups: the 1st-(n=39) who underwent microsurgical discectomy; the 2nd- patients (n=41) operated on using minimally invasive transforaminal interbody fusion and percutaneous transpedicular stabilization (MI-TLIF). For the comparative analysis, we used gender characteristics (gender, age), constitutional characteristics (BMI), degree of physical status according to ASA, intraoperative parameters of interventions and the specificity of postoperative patient management, clinical data, and the presence of complications. Long-term outcomes were assessed at a minimum follow-up of 3 years. As a result, it was found that the use of MI-TLIF allows achieving better long-term clinical outcomes, fewer major complications in comparison with the microsurgical discectomy technique in the treatment of disc herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients.

The foundation of healthy aging is the prevention of disability. In modern medical usage, a syndrome refers to a collection of symptoms and signs with a single underlying cause that may not yet be known. Geriatric syndromes, on the other hand, refer to multifactorial health conditions and occur when the accumulated effects of impairments in multiple systems make an older person vulnerable to situational changes. The use of the term "syndrome" in geriatrics emphasizes the multiple causes of a single manifestation involving an abundance of factors involving multiple organs and systems and is characterized by unique features of common health problems in older adults. It is the geriatric syndromes that can have a significant impact on quality of life and disability. Therefore, early detection of these medical conditions using targeted geriatric assessment is essential in geriatrics. Understanding the essence and feminology of geriatric syndromes, their correct positioning and interpretation is an extremely urgent problem. The main purpose of the presented review is precisely to try to answer these questions. In addition, it has not yet been determined whether geriatric syndromes should be included in the diagnosis (the only exception is sarcopenia syndrome, which was officially included in the 10th International Classification of Diseases in 2016).

The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in comparison with young and middle-aged patients. A total of 81 patients with chronic pyelonephritis in the exacerbation phase were examined. All patients were divided into three age groups according to WHO recommendations: the 1st - 42patients of young age (18-44 years); the 2nd - 17 patients of middle age (45-59 years); the 3rd - 22 elderly patients (60-74 years). Computer morphometry of lymphocytes was performed in all examined patients. In elderly patients with chronic pyelonephritis the size and сytoplasmic-nuclear ratio of lymphocytes increase. This indicates the preservation of lymphocyte defense responses at this age. In male patients with chronic pyelonephritis in the 1st and 2nd age groups the size of lymphocytes increases, and in female patients - decreases. The сytoplasmic-nuclear ratio increases in males of these age groups, while it remains unchanged or decreases in females. Indirect indications of reduced immunity in young and middle-aged women with chronic inflammation in the kidneys have been obtained.

It is widely known that in economically developed countries there is an increase in the proportion of older people. However, the problem of the influence of territorial features of economic development on the rate of population aging is not sufficiently covered. The goal was to study the impact of economic development indicators (EDI) on the processes of premature aging of the population. The materials were statistical collections of the Ministry of Health of Russia and Russian Statistics Service for 2011-2019. The highest incidence was characteristic of cataracts and glaucoma. A direct correlation has been established between the EDI and the age-specific incidence index (ASII) of cataracts (r=0,31; p=0,00436). A group of regions with a high level of economic development was characterized by a higher value of ASII, which, as a rule, corresponds to the later development of the disease.

The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.

In recent years, complications of drug therapy are an important medical problem. Data on adverse drug reactions (ADR) in patients of older age groups were analyzed. The object of the study was notification cards for unwanted reactions received from medical organizations of the Irkutsk region for period 2009-2020 years. The Narangio scale was used to assess the causality between ADR and medicines. Of the 1021 ADR notifications in patients over 65 years of age, 2/3 (668) are presented with ADR notifications in women, 353 (34,6%) in men. The presence of background diseases was registered in 915 notifications (89,6%). There were no gender differences except for a higher incidence of chronic obstructive pulmonary disease in men (7,2 and 3,5% respectively, p<0,05) and diabetes mellitus in women (14 and 3,5% respectively, p<0,05). ADRs for antibacterial agents amounted to 31,8%, drugs for the treatment of cardiovascular diseases - 10,5%, cases of therapeutic inefficiency - 5,1%. The ADR data statement was in line with the recommended form of 76%. The most common filling defect was incomplete patient information. The validity of the Narango causation was high. The deadlines for reporting data were observed in 89,1%. For effective interaction in the pharmacovigilance system, it is necessary in each medical organization to constantly inform about the procedure for pharmacovigilance, types of ADRs, the rules for their detection and the timing of data reporting. The work should be supervised by a trained specialist.

Multi-omics methods for analysing postgenomic data have become firmly established in the tools of molecular gerontology only in recent years, since previously there were no comprehensive integrative approaches adequate to the task of calculating biological age. This paper provides an overview of existing papers on multi-omics integrative approaches in calculating the biological age of a human. An analysis of the most common options for integrating methylomic, transcriptomic, proteomic, microbiomic and metabolomic datasets was carried out. We defined (1) concatenation (machine learning), in which models are developed using a concatenated data matrix, formed by combining multiple omics data sets; (2) fusion model approaches that create multiple intermediate submodels for different omics data to then build a final integrated model from the various intermediate submodels; and (3) transformation methods (via artificial intelligence) that first transform each of the single omics data sets into core plots or matrices, and then combine them all into one graph before building an integral complex model. It is unlikely that multi-omics approaches will find application in anti-aging personalized medicine, but they will undoubtedly deepen and expand the understanding of the fundamental processes standing behind the phenomenon of the biological aging clocks.

In the treatment of coronavirus infections, it is important not only to understand the course of the disease, but also to understand what is happening in the human body, especially in the circulatory system, that is, which disorders lead to deterioration and further complications. Hemostasis disorder in COVID-19 plays an important role in the etiology and clinical manifestations of the disease. The ability to identify factors and risk groups for the development of thrombotic complications, the ability to dynamically interpret peripheral blood parameters and coagulograms, knowledge of diagnostic criteria for possible hemostasis disorders (for example, DIC syndrome, sepsis-associated coagulopathy, antiphospholipids, hemophagocytosis and hypercoagulation syndrome) are necessary to determine the indications for the test. Differentiated prescribing of clinically justified therapy (including anticoagulants and blood components) is important, which determines the complexity of treatment and prognosis for patients with COVID-19. This article is a review of the literature on the topic of hemostasis disorders in elderly and senile patients with mesenteric thrombosis in COVID 19 over the past few years.