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Long distance running (LDR) is an exercise that has a relatively heavy load which can cause Delayed Onset Muscle Soreness (DOMS) and increase Reactive Oxygen Species (ROS) levels. Xanthine, one derivate of ROS will increase 10 times during aerobic activity which is metabolized to Uric Acid (mg/dL) (UA). Foam rolling (FR) is used for the recovery process. This study aims to determine the effect of long distance running on changes in UA levels and the effect of FR as an active recovery against changes in UA levels. This was a quasi-experiment study using a purposive sampling design, one-group repeated measure design of a sample population of young healthy males (17-25 years). The sample consisted of 10 trained young males in Semarang. The average value of UA before intervention was 4.43 mg/dL ± 0.51. In 90 minutes, it was 5.90 mg/dL ± 0.52, in 120 minutes was 5.71 mg/dL ± 0.72 and at 24 hours after intervention was 6.1 mg/dL ± 0.57. LDR has been shown to increase UA levels. FR which is done only once has not been able to reduce UA levels. The percentage of occurrence of post-LDR DOMS occurred at 24 hours.

Background Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. Case presentation A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. Conclusion Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

Background Spontaneous biliary system perforation is a rare presentation in clinical practice especially in adults. It is rarely suspected and diagnosed preoperatively due to small number of cases, vague sign and symptoms, and ambiguous presentation. Case presentation We describe an interesting case of spontaneous perforation of the common bile duct in a 16 year-old female who presented a week after her first birth to the emergency department with complaints of diffuse abdominal pain, abdominal distention, fever, vomiting, and constipation. She was having generalized peritonitis but the etiology was unclear despite a thorough workup. She underwent exploratory laparotomy, and a perforation in the supra duodenal region of the common bile duct was found intraoperatively. The common bile duct was repaired over T-tube, and cholecystectomy was performed; the patient was recovered uneventfully. Conclusion Spontaneous biliary perforation is a rare cause of acute abdomen in adults and extremely rare in pregnancy. Its delayed diagnoses and management can lead to a high morbidity and mortality. All physicians, especially surgeons, should be aware of this possibility and consider it a cause of peritonitis on differential diagnosis particularly when there is no apparent etiology available for presentation.

Introduction: Colistimethate sodium (CMS) is a polymyxin group of antibiotics which were throw out for many years, due to their potential adverse reaction neurotoxicity and nephrotoxicity. The different guidelines were reported regarding CMS dosing some based on Creatinine clearance (CrCl) and some on weight and CrCl. There are many discrepancies in the prevalence of nephrotoxicity that has been reported which included various definitions of acute renal injury and many CMS doses used in a variety of literature. In EMA guideline they suggested the dose as 9 MIU which is equivalent to 300 mg of CBA given as a maintenance dose with normal renal function patients. In FDA standard dosing of CMS remains 5 mg/kg CBA per day used and also dose is dependent on patient weight. The aim of this study was to evaluate the dosing criteria of colistimethate sodium associated with nephrotoxicity. Methodology: A prospective observational study was conducted in private sector tertiary care hospital in Karachi, Pakistan, for duration of six months from July 2020 to December 2020. Sample size was comprised of 157 patients, calculated at 35% prevalence, 95% Confidence Interval and 7% margin of error. Patient included were ≥ 18 years of age, who have received intravenous CMS therapy for greater than 48 hours. Patients having an acute kidney injury or on dialysis (at start of therapy) were excluded. Loading dose and daily dose of CMS was calculated by using actual body weight and Creatinine clearance (CrCl). Cockcroft and Gault equation was used to estimate CrCl before and after the therapy. Nephrotoxicity was assessed by using the RIFLE criteria. SPSS-20 was used for frequency distribution and percentage calculation to show categorical variable. Results: Among 157 enrolled patients, 101 (64.3%) were male and 56(35.7%) were female (Table 1). Table 2. represents that 68(43.3%) patients were admitted in intensive care unit (ICU) and 89(56.7%) were in medicinal ward; 22.9% patients were in between the age range 60-70 years (Table 3). Among all patients 63(40.1%) patients were at risk of nephrotoxicity, 27(17.2%) patients were developing injury and 14(8.9%) patients were diagnosed to kidney failure and 53(33.8%) patients were found not to developed nephrotoxicity (Table 4). Table 5 exhibits that 48.4% of the patients were receiving dose of CMS using EMA guideline while 51.6% patients were receiving dose of CMS 2.5-5 mgCBA/kg/day according to FDA. Nephrotoxicity was high among FDA regimen (44.5%). Conclusion: It was concluded that CMS dosing criteria have a significant impact on nephrotoxicity. Close monitoring of renal function, particularly the first week of CMS therapy should be considered to evaluate the renal toxicity of CMS.

Mansour Abdullah Alshehri,1,2 Jamal Alzaidi,3 Sultan Alasmari,3 Ali Alfaqeh,3 Mohammad Arif,3 Sultan Falh Alotaiby,4 Hosam Alzahrani5 1Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia; 2NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia; 3Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Mecca, Saudi Arabia; 4Physiotherapy Department, Hira General Hospital, Mecca, Saudi Arabia; 5Physiotherapy Department, College of Applied Medical Science, Taif University, Taif, Saudi ArabiaCorrespondence: Mansour Abdullah AlshehriPhysiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Awali, Mecca, 24381, Saudi ArabiaTel +966569693637Email mamshehri@uqu.edu.saBackground: Musculoskeletal pain is a primary burden on individuals as well as social and health care systems. Annually, 2– 3 million pilgrims perform the Hajj in Mecca, Saudi Arabia. The Hajj is highly physically demanding because pilgrims generally move by foot for long distances among a series of religious sites, an effort that may exceed their typical levels of physical activity. To understand the impact of musculoskeletal pain on the completion of the Hajj, it is first necessary to evaluate the extent of the problem. Accordingly, this study aimed to estimate the prevalence of musculoskeletal pain and associated factors among pilgrims during the Hajj.Methods: A cross-sectional survey was conducted during the period of the Hajj. The participants were adult pilgrims ≥ 18 years of age. Data regarding demographics, the prevalence of falls and the point prevalence of musculoskeletal pain by anatomical site were recorded. Participants were allowed to report more than one site of pain. Prevalence, crude and adjusted risk ratios were calculated.Results: A total of 1715 pilgrims were included in the analysis. The prevalence of falls was 13.76%. The prevalence of overall musculoskeletal pain (pain at any site) was 80.46%. Musculoskeletal pain was most commonly reported in the ankle/foot (38.34%), leg (29.89%), lower back (28.47%) and knee (21.84%). In general, musculoskeletal pain at multiple sites was more common in females and in older and obese individuals. However, there were variations in the importance of sex, age and body mass index as associated factors across different pain sites.Conclusion: Musculoskeletal pain is common among pilgrims. Unlike most populations examined in other studies, ankle/foot pain was the most common in pilgrims. These data provide guidance for potential preventative programs and the allocation of resources to optimize pilgrims’ experiences and ability to complete the Hajj.Keywords: musculoskeletal pain, falls, sex, age, BMI, Hajj

Background: Colorectal carcinoma is the fourth most commonly diagnosed cancer and the third leading cause of cancer deaths worldwide. The rectum is the most frequent site involved. The disease is no less common in our country in comparison to western world. The aim of this study was to determine the incidence and to review the clinicopathological aspects of carcinoma rectum in different ages in our country. Methods: This is a prospective observational study which includes 50 cases of carcinoma rectum which were admitted under different surgical units of Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University during the period of November 2007 to December 2008. Results: The present study showed maximum incidence of carcinoma rectum in the age group 21-30 years. Next common age group was 31-40 years. Incidence declined after 60 years. Majority of victims were male giving a male to female ratio of 1.17:1. As regards the mode of clinical presentation, most patients presented with bleeding per rectum. Majority of patients in this study was moderately anaemic. Curative resection was possible in 54% cases, palliative resection in 38% and palliative end colostomy was done in 4% cases. Only 2% mortality was reported in this study. Histopathological grading showed that poorly differentiated adenocarcinoma of rectum was more common in younger age group. Conclusion: Younger patients with carcinoma rectum have several distinct clinicopathological features. Since early diagnosis is essential to improve the cure rate for carcinoma rectum, all known procedure tools must be used to detect carcinoma of the rectum in an early stage, in addition to periodic selective investigations of high-risk group. Journal of Surgical Sciences (2020) Vol. 24 (1) : 15-20

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and there is not yet a cure. Not only in Bangladesh but also worldwide the incidence of COPD is increasing. The disease is associated with some metabolic derangement such as electrolytes imbalance. Those factors further worsen the disease course. As a result COPD related morbidity, mortality and cost to health systems are also increasing. This cross-sectional observational study was conducted in Faridpur Medical College Hospital (FMCH) over 6 months among 100 patients who were admitted with acute exacerbation of COPD. The mean age was (58.13 ± 9.96) years. In this study serum electrolytes were found below the normal range in 68 (68%) cases and within normal range in 32(32%) cases. Isolated hyponatremia was observed in 36(53%) and 15(22%) had isolated hypokalaemia. Both hyponatremia and hypokalaemia was found in 17(25%) cases. The mean serum sodium level was (133.82±2.52) mmol/l. Among patients with isolated hyponatremia, 24(67%) had mild hyponatremia and 12(33%) got moderate hyponatremia. Again the mean serum potassium was (3.45±0.23) mmol/l. Among patients with isolated hypokalaemia, 10(67%) had mild hypokalaemia and 5(33%) had moderate hypokalaemia. Both hyponatremia and hypokalaemia was observed in one fourth of total electrolytes depleted cases and all were within the mild range. No patient had severe hyponatremia or hypokalaemia. Faridpur Med. Coll. J. Jan 2020;15(1): 24-27

The occurrence of COVID-19 which causes severe acute respiratory infection has produced a large global outbreak with major public health concern. Since Chinese wet market (LBM) has been blamed to be linked with this global pandemic of COVID-19 as the noble virus has supposed to be transmitted from a wild species, however, this is not yet established the association of SARS-Cov-2 transmission via animal to human or food chain. Moreover, it has been recognized to spread human-to-human transmission by inhalation of droplets or direct contact. Besides the devastating effects of SARS-Cov-2, world has been experiencing the impact of food safety and security as the effect due to global lockdown resulting a wide range of new challenges of economic growth and societal burden. In this review, we have focused on effect of corona virus on food system that included food safety, food security during lockdown, and prevention and control options have been emphasized to keep normalcy of livelihood of general people in low and middle income countries (LMICs). Since the global economy has been downed deeper into a financial crunch, the government efforts are underway to bolster up the priorities with the limited resources, and further funding allocation decision is obligatory for the targeted communities those are affected most due to the swath of pandemic threat of COVID-19. Asian J. Med. Biol. Res. June 2020, 6(2): 130-137

Objective: To determine the nasal carriage of staphylococcus aureus and methicillin-resistant staphylococcus aureus among healthcare workers in a tertiary care setting. Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from April to July 2018, and comprised healthcare workers at the institution. Nasal swabs were collected and cultured on Mannitol salt agar. Mannitol fermenting colonies which were gram-positive cocci, catalase-positive and coagulase-positive were identified as staphylococcus aureus. Antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method. Methicillin resistance was detected using cefoxitin disc diffusion method. Data was analysed using SPSS 23. Results: Of the 210 nasal swabs, 52(24.76%) had a staphylococcus aureus growth, and, of them, 15(7.1%) were methicillin-resistant. No association could be established with either any single category of healthcare worker or an inter-department variation (p>0.05). Likewise, there was no association with age, gender, duration of service, smoking, co-morbidities, use of antibiotics in the preceding six months, treating a patient with methicillin-resistant staphylococcus aureus in the preceding six months and hospitalisation in the preceding year (p>0.05). Conclusion: The frequency of nasal carriage of methicillin resistant staphylococcus aureus amongst healthcare workers was regardless of the nature of their professional engagement. Key Words: Methicillin resistant staphylococcus aureus, Nasal carriage, Continuous...

Objective: Self-medication with antibiotics (SMA) is a common cause of antibiotic resistance, a major public health problem. This research aimed to identify the prevalence of SMA and explore reasons for practicing SMA among people living in Kabul, Afghanistan.Methods: A community-based cross-sectional study was conducted from May to November 2017 in 12 community pharmacies operating across Kabul, Afghanistan. Multivariable logistic regression was conducted to identify the factors associated with the use of SMA.Results: Out of 385 participants, 282 (73.2%) practiced SMA during the last year. Overall, 241 (62.6%) were 'very concerned' about the use of SMA, and 156 (40.5%) highlighted it is bad to practice SMA. The top three antibiotics used for self-medication were penicillin (ATC class: J01C), metronidazole (ATC: P01AB01), and ceftriaxone (ATC: J01DD04). Economic problems, lack of time to visit doctors, and ease of use were cited as the main reasons for practicing SMA. Furthermore, female participants were less likely to practice SMA compared to male counterparts.Conclusion: While efforts should be directed to enforce strict drug regulations system and awareness programs, priority should be given to provide accessible, affordable, and quality health care services to increase citizen's compliance to appropriate drug prescriptions.

Subacute sclerosing panencephalitis (SSPE) is chronic progressive encephalitis of childhood and young adoloscent due to persistent measles virus infection. This case illustrates a 14 year old girl presented with short history of intellectual decline, abnormal behavior, myoclonus and altered consciousness with suggestive neuroimaging mimicking metachromatic leucodystrophy. Subsequently she was diagnosed to be a case of Subacute sclerosing panencephalitis (SSPE) on the basis of Electroencephalography (EEG) and Cerebrospinal fluid(CSF) measles antibody titer. J Bangladesh Coll Phys Surg 2019; 37(4): 205-208

Lysosomes are an essential organ for cellular metabolism and play an important role in autophagy. We examined the association between methylation and autophagy in a severely affected female patient with Fabry disease, which is caused by mutation of the GLA gene on the X chromosome, and her two sisters, who had few symptoms. We confirmed autophagic flux by LC3 turnover assay using fibroblasts from each sister. In the severe female patient, autophagic flux showed abnormal while her two sisters with few symptoms had normal autophagic flux, revealing the direct relationship between symptoms and autophagic flux. Furthermore, we observed the levels of p62, which is a substrate for autophagy, and lysosome morphology. In the severe patient of this family, lysosomes were enlarged and p62 was accumulated. The methylated allele of the GLA gene in the severe patient had a high proportion of wild alleles; conversely, the sisters' methylated allele had a high proportion of mutant alleles. Therefore, we examined the mRNA expression level of the mutant allele by allele-specific PCR. It was high in the severe patient and low in the siblings with few symptoms. That is, the correlation between the mRNA expression level of the mutant allele and disease severity was confirmed. We showed a correlation between severe symptoms, dysfunction of autophagy and methylation of wild alleles in Fabry disease. It was suggested that allele-specific PCR may lead to a diagnosis and help to determine the prognosis of female patients with Fabry disease.

BackgroundPre-exposure prophylaxis (PrEP) is a promising strategy to break the chain of transmission of novel coronavirus (2019-nCoV).AimsThis trial aimed to evaluate the safety and efficacy of PrEP with various doses of HCQ against a placebo among high-risk healthcare providers (HCPs).MethodsA phase II, randomized, placebo-controlled trial was conducted at a tertiary care hospital. A total of 228 HCPs were screened, we included 200 subjects with no active or past SARS-CoV-2 infection. Subjects of experimental groups 1-3 received HCQ in various doses and those in the control group received placebo. The study outcomes in terms of safety and efficacy were monitored. Participants exhibiting COVID-19 symptoms were tested for SARS-CoV-2 during the study and also by the end of the 12th week, with PCR or IgM and IgG serology.ResultsOverall, 146 of 200 participants reported exposure to a confirmed COVID-19 case in the first month, 189 in the 2nd month and 192 were exposed by the 12th week of the study. Moreover, the precautionary practices, i.e. use of personal protective equipment (PPE), significantly varied; initially more than 80% of the exposed HCPs weren’t ensuring the PPE used by the patients treated by them. However, it gradually developed with the increasing knowledge of the virus. As far as safety is concerned, mild treatment-related side effects were observed among the interventional and placebo arm patients. While none of the participants were critical, and a few had mild illness by the end of the 12th week, requiring only outpatient observation with no hospitalization. There was no significant clinical benefit of PrEP with HCQ as compared to placebo (p>0.05).ConclusionIt is concluded from the study findings that the PrEP HCQ does not significantly prevent illness compatible with COVID-19 or confirmed infection among high-risk HCPs.

Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes., Author summary The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of SDR to eligible contacts of newly diagnosed leprosy patients in states or districts of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. This study investigated the long-term impact of the LPEP program on the leprosy new case detection rate (NCDR). Our results show that LPEP could reduce the NCDR beyond the impact of the routine leprosy control programme and that many new cases could be prevented. The benefit of LPEP increases gradually over time. LPEP could accelerate the time of reaching predicted NCDR levels of 2040 under routine program by up to six years. Furthermore, we highlighted how the impact varies between countries due to differences in the number of contacts per index patient screened and differences in leprosy epidemiology and national control programme. Generally, including both household contacts and neighbours (> 20 contacts per index patient) would yield the highest impact.

Background: Diabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system. Method: For designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features. Results: Top-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%-90%, and above 90%, respectively. Conclusions: The findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients. 2021 This research is financially supported by Xiamen University Malaysia, Project number XMUMRF/2018-C2/IECE/0002; Universiti Kebangsaan Malaysia (UKM), Grant Number DPK-2021-001, GP-2020-K017701 and MI-2020-002 and Qatar National Research Foundation (QNRF), grant no. NPRP12s-0227-190164 and International Research Collaboration Co-Fund (IRCC) grant: IRCC-2021-001.We would like to thank the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for providing the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) and Diabetes Prevention Program Outcomes Study (DPPOS) database. The Diabetes Control and Complications Trial (DCCT) and its follow-up the Epidemiology of Diabetes Interventions and Complications (EDIC) study were conducted by the DCCT/EDIC Research Group and supported by National Institute of Health grants and contracts and by the General Clinical Research Center Program, NCRR. The Diabetes Prevention Program outcome study (DPPOS) was conducted by the DPP Research Group and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the General Clinical Research Center Program, the National Institute of Child Health and Human Development (NICHD), the National Institute on Aging (NIA), the Office of Research on Women's Health, the Office of Research on Minority Health, the Centers for Disease Control and Prevention (CDC), and the American Diabetes Association. The data [and samples] from the DCCT/EDIC and DPPOS study were supplied by the NIDDK Central Repositories. This manuscript was not prepared under the auspices of the DCCT/EDIC and DPPOS and does not represent analyses or conclusions of the DPP Research Group, the NIDDK Central Repositories, or the NIH. The database is available on request from the NIDDK websites. EDIC database:, https://repository.niddk.nih.gov/studies/edic/and DPPOS database: https://repository.niddk.nih.gov/studies/dppos/ Scopus

Objectives: A pilot study was executed in the month of June- July 2020 in Qazi Hussain Ahmed Medical complex Nowshera with aim to determine the gender protective role in term of production of neutralizing Anti SARS-COV-2 antibodies. Material and methods: A total of 39 COVID-19 patients who recovered from COVID-19 were selected. Their antibodies cut off values were measured by electro-chemiluminescence immunoassay using Roche Cobas E411 Chemistry Analyzer for which commercial kits of Roche diagnostics were used as per the instructions of the manufacturer. Results: A statistically significant difference in mean post infection antibodies level was observed with higher cut off values in patient who had symptoms at time of being reported positive by PCR as compared to patient who were asymptomatic (p-value:0.04). Using Kaplan Meir it was predicted that in female gender, the probability of survival is 100% at cut off antibodies levels of 50, While a vertical drop up to less than 40% of probability of survival was predicted in male gender even at higher antibodies levels of >100, that supports the prediction of production of higher levels of antibodies in female gender in early infections. Conclusion: The female gender produces higher titer of antibodies in early infections to confer immunity in COVID-19.

This is a report of rare cases of full-term infants born with persistent tunica vasculosa lentis (TVL) with no retinopathy of prematurity (ROP) and no plus disease. This condition can be mistaken with iris vascular enlargement-associated plus disease, leading to unnecessary laser or intravitreal injections. The cases were treated with close observation, which resulted in complete resolution of the TVL. In conclusion, we encourage the diagnosis of TVL and careful monitoring of such cases before the intervention, as the condition may revert completely.

The world is currently suffering from another episode of respiratory disease pandemic as Coronavirus Disease 2019 (COVID-19) spares no continent. The disease which is caused by the virus SARS-CoV-2, has so far claimed many lives in multiple countries, including Muslim majority nations like Malaysia and Saudi Arabia. The situation has become a significant public health concern with several measures being carried out in an attempt to break the chain of the virus transmission. These include the introduction of movement control order and total lock down across the world. The closure of places of worship including mosques have raised concerns and inconvenience to Muslims. Pandemics are not unprecedented in the history of mankind as several documented outbreaks like the plague pandemic in the mid fourteenth century also known as ‘the Black Death’, caused a demographic decline in both Muslim and Christian countries which led to millions of lives loss worldwide. We attempt to identify the parallels between the current COVID-19 pandemic with the experiences of previous Muslim generations, and draw lessons on general and practical responses to pandemics with special reference to the generation of the Prophet’s companion.

BackgroundNiemann-Pick disease type C (NPC) is an autosomal recessive disorder caused by mutations of NPC1 or NPC2, which encode the proteins that are responsible for intracellular cholesterol trafficking. Loss of this function results in the accumulation of cholesterol-related products, such as oxysterols, sphingolipids, and NPC-related bile acids, which were recently used as biochemical biomarkers for the diagnosis of NPC. Bile acid-408 is a new significant compound we found in Japanese NPC patients, and it likely belongs to the category of bile acids. However, the diagnosis of NPC using a single biomarker is not satisfactory for clinical application because of the high instance of false negatives or positives. Therefore, we proposed an application of NPC diagnosis using a combination of 7-ketocholesterol (7-KC), lysosphingomyelin (lysoSM), bile acid-408 and/or glucosylsphingosine (lysoGL-1).Methods and findings7-KC, lysoSM and lysoGL-1 in sera and bile acid-408 in dried blood spots (DBS) were quantified within 17 minutes using tandem mass spectrometry and high-resolution mass spectrometry, respectively. We measured these biomarkers in NPC patients (n = 19), X-linked adrenoleukodystrophy (X-ALD) patients (n = 5), patients with other lysosomal diseases (n = 300), newborns (n = 124) and healthy people (n = 74). Our results showed a promising accuracy (97%) for NPC diagnosis using the combination of 7-KC, lysoSM and bile acid-408. However, contrary to our expectations, lysoGL-1 levels did not present at a significantly greater amount in NPC patients than other patients and negative controls.ConclusionsThe combination of 7-KC, lysoSM and bile acid-408 improves the accuracy of NPC diagnosis and is feasible for mass screening due to its simple sample preparation and measurement. Future research should investigate the chemical structure of bile acid-408 to further facilitate its advantage in diagnosis.

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation., Author summary Leprosy is an infectious disease caused by the Mycobacterium leprae and is one of the major causes of preventable disability in low- and middle-income countries. Disabled people face lifelong socioeconomic challenges and are often excluded from society. It brings people affected by leprosy in a vicious cycle of poverty and disability. This cycle needs to be curbed through scientific evidence on health economic aspects of leprosy. Unfortunately, there is not much literature available on cost or cost-effectiveness of leprosy prevention. New prevention methods such as post-exposure chemoprophylaxis are now available, providing opportunity to collect up-to-date health economic evidence to support health policy and planning. Here, we present a cost-effectiveness study of contact screening in combination of post-exposure prophylaxis with single-dose rifampicin in the Union Territory of Dadra Nagar Haveli in India. We compare the intervention with the continuation of the routine leprosy control programme. As leprosy is moving towards elimination, evidence from this study will contribute to an investment case for leprosy elimination.

Epidural hematoma is a life-threatening complication of head injury, which often occurs as a result of blunt trauma to the skull. Unregulated hematoma expansion in any setting results in elevated intracranial pressure and may contribute to the compression of the oculomotor nerve among several other adversities culminating in various long-lasting complications in the future. In this case report, we present the findings of a rare, insightful case of a 47-year-old Southeast Asian male with no established prior medical history apart from being a victim of blunt trauma attributable to a fall four days before presenting to the emergency department with abrupt onset of diplopia and drooping of the left eyelid. The initial physical examination helped to establish a diagnosis of third nerve palsy. A non-contrast CT of the head was conducted, and its findings revealed the presence of a right temporal-parietal-occipital epidural hemorrhage, with no mass impact on the cerebral hemisphere. The patient later underwent a successful left temporoparietal craniotomy, during which 100-125 ml of blood was drained out. Post-surgery, a near-full reduction of ptosis was recorded at the end of the first week. This case report summarizes this ingenious depiction of a partial third nerve palsy presenting as the sole sign of the epidural hemorrhage in a cognizant patient.

Introduction: The purpose of this study was to find, the prevalence of self-medication with antibiotics, and antibiotics used for self-treated disease.Methods: this cross-sectional study was carried out among 385 participants in 12 community pharmacies located in 4 different regions of Kabul from May to November 2017. Standard questionnaire based on similar studies was designed and distributed among participants. Data was collected and analyzed in SPSS 16.0.Results: out of 385 participants (61.29% male and 38.70% female) 282 persons (73.25%) had practiced antibiotic self-medication during last year. The common reasons for antibiotic self-medication was economic problems (26.95%), lack of time (22.69%), comfortability (21.63%), lack of confidence on health care system (17.37%), and poor access to health care facilities (11.34%). Conditions like cough (28.01%), common cold (14.89%), respiratory infections (13.47%), sore throat (12.41%) and diarrhea (7.44%) were commonly self-medicated with antibiotics. penicillins (25.17%), metronidazole (15.60%), ceftriaxone (14.18%), tetracycline (10.28%), Azithromycin (9.21%), cefixime (7.09%), ciprofloxacin (6.73%) were mostly used for self-medication. 93 (32.97%) respondents had experienced side effects during antibiotic self-medication. Conclusions: The prevalence of antibiotic self-medication is very high (75.53%) in Kabul and this widespread antibiotic use has increased the risk of antibiotic resistance. Awareness and Strict rules for selling antibiotics without prescription should be developed and implemented to improve the rational use of antibiotics. Only pharmacists or professional peoples should be permitted to work in pharmacies. The quality, accessibility and cost of health care services should be enhanced in order to improve patient’ satisfaction in health care system.

Studies on excised aldosterone-producing lesions have found somatic mutations in five genes (KCNJ5, CACNA1D, ATP1A1, ATP2B3, and CTNNB1) commonly causes the excess aldosterone production. Interestingly, Oriental cohorts had the highest frequency of KCNJ5 mutations whereas CACNA1D mutations were most common in Black African Caribbean patients, suggesting that genetic background affects the prevalence and distribution of aldosterone-driving somatic mutation. We therefore aimed to identify the common germline variants that associates with excess aldosterone production through performing a pilot genome wide association study (GWAS) on primary aldosteronism (PA) patients. GWAS was performed using the Human Infinium OmniExpressExome-8 v1.4 BeadChip containing 960,919 markers to compare gDNA of 154 PA patients with 78 healthy controls. Samples were checked for sex discordance, heterozygosity rate, missing rate and the degree of recent shared ancestry for each pair of individuals using the PLINK program and Genome Studio (Illumina). In total, 150 patients and 75 controls (112 males and 113 females) were included in the downstream analysis. 630,749 markers that passed quality control steps (missing call rate 1%) were used to perform association analysis using the Chi-square Test which was then subjected to multiple testing corrections (Bonferroni correction). As expected with a pilot sample size, no variants passed the suggestive significant threshold of Bonferroni corrected P-value < 5 x 10-6 (-log10 P = 5.3). However, 27 SNPs had the uncorrected P-value2, and differences of frequencies in cases compared to control >0.1 or References aChu et al., Int J Clin Exp Pathol 2017;10(9):10009-10018. bTanaka et al., Hypertens Res 2019;42(2):165-173. cNogueira et al., Mol Cell Endocrinol 2009; 302(2): 230–236. dGTEx Analysis Release V7 (dbGaP Accession phs000424.v7.p2) Acknowledgements This research was supported by the Malaysian Ministry of Higher Education Grant (FRGS/1/2015/SKK08/UKM/02/3), The National University of Malaysia (UKM) University Grant (GUP-2016-083), and The UKM Medical Center Fundamental Grant (FF-2016-302).

Primary aldosteronism (PA), also known as Conn’s syndrome, is a common curable cause of hypertension. Family studies of essential hypertensive patients suggest that heritable genetic factors play a role in blood pressure regulation1. Interestingly, single nucleotide polymorphisms (SNP) in genes encoding enzymes involved with adrenal steroidogenesis, CYP11B2, CYP11B1 and CYP17A1, associate with increased risk of hypertension2. Therefore, we analysed whether selected SNPs in these genes are associated with PA. We performed an association study using genotype imputation for selected SNPs of the steroidogenic enzyme genes CYP11B2 (rs4546, rs1799998, rs13268025), CYP11B1 (rs6410, rs149845727), and CYP17A1 (rs1004467, rs138009835, rs2150927) from a pilot genome wide association study of Malaysian PA patients and healthy controls which was merged with the Singapore Genome Variation Project (SGVP) population dataset3. Genotype imputation for minor and major alleles was validated using PCR sequencing (n>10 for each genotype). Further, one SNP from each steroidogenic enzyme (CYP11B2:rs1799998, CYP11B1:rs6410 and CYP17A1:rs1004467) was validated using commercial TaqMan genotyping assays on the ABI 7000 Sequence Detection System which was performed on 149 PA patients and 78 non-hypertensive healthy individuals. Case-control genetic association analysis was performed at http://www.oege.org/software/orcalc.html and the association between genotypes and phenotypes was done using the independent-samples Kruskal-Wallis test on SPSS (version 25). The Minor Allele Frequencies (MAFs) for rs1004467, rs6410 and rs1799998 were similar to East Asian populations but differed significantly different from European, African, American and South Asian populations (rs1004467 MAF: C=0.258/298, rs6410 MAF: A=0.265/298, rs1799998 MAF: C=0.225/298). In Chinese patients matched by gender, heterozygotes for rs6410 had significantly increased risk of PA compared to common homozygotes (OR: 3.15, 95% CI: 1.01–9.8, p=0.04). Across patients of different ethnicity, the distribution of aldosterone levels was significantly different (p=0.039). In summary, only SNP rs6410 in Chinese patients matched by gender showed association with PA in our South East Asian cohort. More functional experiments need to be done to find out whether this is causal for PA or whether the SNP is in linkage disequilibrium with the actual functional causative SNPs. Once the functional SNP is known, identification of these germline variants in asymptomatic family members would allow early screening of PA to be offered and potentially provide novel drug targets to treat the disease. References: 1Timberlake et al., Curr Opin Nephrol Hypertens. 2001 Jan;10(1):71-9. 2MacKenzie et al., Int J Mol Sci. 2017 Mar 7;18(3). pii: E579. 3Teo et al., Genome Res. 2009 Nov;19(11):2154-62.

Introduction: Systolic Time Interval (STI) is a simple,noninvasive and precise technique to assess left ventricular (LV) function. It measures aortic Pre-Ejection Period (PEP) over Left Ventricular Ejection Time (LVET) from echocardiogram. Thyrotoxicosis will enhance LV function and cause reduction of STI. This study was perform to measure the changes of STI after administration of high dose L-thyroxine and to determine the correlation between high dose L-thyroxine administration and STI. Materials and Method: A Total of 22 patients were screened. Those with cardiac diseases and high Framingham risk score were excluded. Nine patients were started on high dose L-thyroxine (7x their usual dose) once a week during the month of Ramadan.Thyroid hormones ( T3,T4,TSH)Â and STI (PEP/LVET) were measured at baseline and within 24 hrs after high dose L-thyroxine ingestion. Results: All patients have normal thyroid hormones level and normal cardiac function at baseline. The median dose (mcg) of L-thyroxine was 600 (437.5,700) while the median level of fT4 (pmol/L) was 17.43(12.38,20.8). Despite the significant increment of fT4 after Lthyroxine ingestion [baseline 13.21(8.19,14.63) vs high dose 17.43(12.38,22.55) p; 0.011] there was no significant change in STI [baseline 0.3(0.2,0.4) vs high dose 0.28(0.26,0.45) p; 0.513]. There was no correlation found between the dose of Lthyroxine and STI (r=0.244 , p;0.526). Conclusion: Administration of high dose Lthyroxine did not significantly alter STI despite significant increment of fT4 level unlike the naturally occurring thyrotoxicosis.Therefore ‘exogenous’ administration of high dose L-thyroxine is cardiac safe.

Summary Background Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established. Funding Novartis Foundation.

Flexibility is one key of physical fitness components, it is quite important to sup-port daily activity and sport performances. This study aims to identify what type of physical exercises induce muscle damage, to evaluate changes in flexibility (ROM), and to identify potential flexibility training. Original studies which no longer than ten years were considered in this study (secondary data), and other significant references also acceptable to support the storylines. The first step was codifying, followed by analysis and synthesis, and last step was conclusion drawing. It must be done sequentially to reveal the reasonable answers. Eccentric muscle contraction, exessive volume, and prolonged duration are factors of train-ing which lead muscle injuries. ROM is decreased due to muscle damage, it last longer in untrained men. Stretching, foam rolling, sport massage, Propioceptive Neuromuschular Facilitation (PNF) are potential flexibility trainings might be able to improve ROM and accelerate healing process in muscle damaged.

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of

Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A (α-gal A), leading to the progressive accumulation of glycosphingolipids. Classical hemizygous males usually present symptoms, including pain and paresthesia in the extremities, angiokeratoma, hypo- or anhidrosis, abdominal pain, cornea verticillata, early stroke, tinnitus, and/or hearing loss, during early childhood or adolescence. Moreover, proteinuria, renal impairment, and cardiac hypertrophy can appear with age. Enzyme replacement is the most common therapy for Fabry disease at present which has been approved in Japan since 2004. We report a case involving a 27-year-old male with extreme terminal pain, anhidrosis, abdominal pain, tinnitus, hearing impairment, cornea verticillata, and recurrent huge ulcers in the lower extremities. At the age of 16 years, he was diagnosed with Fabry disease with a positive family history and very low α-gal A activity. He then received enzyme replacement therapy (ERT) with recombinant human agalsidase beta at 1 mg/kg every 2 weeks for 10 years. Throughout the course of ERT, his leg ulcers recurred, and massive excretion of urinary globotriaosylceramide and plasma globotriaosylsphingosine was observed. Electron microscopy of the venous tissue in the regions of the ulcer showed massive typical zebra bodies in the vascular wall smooth muscle cells., Highlights • A classical hemizygous male with Fabry disease presented with massive intractable leg ulcer. • 10 years' enzyme replacement therapy showed huge excretion of urinary Gb3 and plasma lyso-Gb3. • Excessive zebra bodies in vascular wall smooth muscle cells caused venous reflux and varices on saphenous veins.

Burkholderia pseudomallei is a known motile organism in soil. Its infection is usually described in immunocompromised patients. It inflicts serious infection with high mortality and morbidity rate. We report a rare case of an end-stage renal disease patient on regular continuous ambulatory peritoneal dialysis (PD) who developed melioidosis PD peritonitis. Within a short period of time, she developed encapsulating peritoneal sclerosis evidenced by the intraoperative findings of intraabdominal cocooning. Choice and duration of antibiotic are important for proper eradication of the organism. Early diagnosis and treatment of both conditions also may improve the prognoses.

Evans syndrome is a haematological disorder characterized by the sequential or simultaneous development of direct antiglobulin test (DAT) positive autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and/or immune neutropenia in the absence of a known aetiology. No sex predilection is known. It may occur in all ethnic groups and all ages. This condition generally runs a chronic course and is characterized by frequent exacerbations and remissions. Here we report a case of a female who presented with both acute decompensated anaemia & thrombocytopenia. She received total 5 bags blood within 10 days for correction of anaemia but patients condition was deteriorating. CBC with PBF showed features consistent with immune haemolytic anaemia with thrombocytopenia, marked roulaeux formation and reticulocytosis. Direct Coomb's test (DAT) was positive and Indirect coomb's test was (IAT) negative. Her general condition was improved after injection methyl prednisolone for 3 days followed by oral prednisolone. Follow up CBC showed increased haemoglobin and platelet count without blood transfusion.Faridpur Med. Coll. J. Jul 2017;12(2): 88-91

Objective : Patients beliefs determine their response to an illness and its management especially if it is chronic. Studies assessing patient’s knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge, attitude and practices of epilepsy patients referred to a tertiary care centre in East Coast of Malaysia. Materials and Methods : A cross sectional study using pre-tested, semi-structured questionnaire among consenting epilepsy patients. Results : The demographic details and responses to a questionnaire assessing their insight towards epilepsy were recorded. Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean = 31.63 ± 13.41). Majority (53.8%) of them aged equal or less than 30 years. The median number of years they had epilepsy was 8.0 (4.0, 18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (0.3, 4.5) years. The average number of years they were receiving treatment from a hospital was 5.50 ± 5.84. Most (90.9%) did not know the cause of epilepsy; however 93.9 % were aware that it can be treated with modern drugs. While only 22.7 % believed that faith healers can treat epilepsy, 74.2% had tried other forms of treatment. Negative attitude was reflected in the belief that epilepsy is due to supernatural powers (1.5%) and that epilepsy is contagious (17.4 %). Positive attitude included that PWE can take a job (66.7%), allowing a child with epilepsy to study (80%), not objecting children to play with a child with epilepsy (54.5%), marry (65.9%) and having children (58.3%). Conclusions : Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. The results suggest that there is a critical need to enhance epilepsy education and improve attitudes towards epilepsy beyond seizure control. Bangladesh Journal of Medical Science Vol.16(4) 2017 p.545-553

Pelvic inflammatory disease is an important and major health problem in Bangladesh. This study was undertaken to find out the common clinical presentation of pelvic inflammatory disease in relation to reproductive health of women in our country. This study has been carried out at the outpatient department of Obstetrics and Gynaecology, Sher- EBangla Medical College Hospital, Barisal, during period from January 2010 to December 2010. In this descriptive type of cross sectional study, total number of 150 patients suffering from PID were selected. Details history and thorough clinical examination was performed with the aim of find out clinical presentation of PID. Related investigations were done. This study shows that 54% belongs to age group 26-35 years, 90% patients were married and 4% were separated, 90% were house wifes, 60% patients were from lower socio-economic status. All patients complained lower abdominal pain, 60% had vaginal discharge, 80% patients delivered solely at home and 73.33% were delivered by untrained birth attendants at home. Pelvic inflammatory disease is detrimental to reproductive health and makes the women cripple physically, mentally and socially. So appropriate measures e.g. better obstetric and delivery care, family planning care, safe way of pregnancy termination; health education etc. should be made for our women.Faridpur Med. Coll. J. Jan 2017;12(1): 25-30

Arterial Hypertension is the most common cardiovascular disease and is a major public health problem in both developed and developing countries. The aim of the study was to assess renal involvement in hypertensive patient by renogram, which is not detected by conventional biochemical test. This was a cross sectional observational study. Consecutive 30 hypertensive patients admitted in the medicine wards from March, 2006 to April, 2007 in Rajshahi Medical College Hospital, Bangladesh were taken as case. Informed consent was taken from all the study patients or from their attendants. Detail history was taken from each patient or from their attendants' then clinical examination and relevant investigations were done. Emphasis was laid to find out renal involvement in long standing hypertensive patients by renogram. After initial selection; laboratory investigations like Urine for R/M/E, Blood Sugar 2ABF, S. Creatinine, USG of KUB, ECG and Hb% were done for every patients. All patients included in this study renogram were done. Majority of the patient (40%) were between the age of 41-50 years and Male: Female ratio was 3:2. Most of the patient lead a moderately active life (66.67%). Serum Creatinine was raised in 23.33% patient whereas renal parenchymal insufficiency evidenced by renogram was found in 50% case. In this study, we found that a significant number of cases (26.67%) having renal parenchymal insufficiency were not detected by S. Creatinine level, but detected by renogram. Renogram is superior to conventional biochemical renal function test for early detection of hypertensive nephropathy.Faridpur Med. Coll. J. Jan 2016;11(1): 11-14

Patient: Male, 63 Final Diagnosis: Bilateral subclavian artery stenosis Symptoms: Hypotension Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare disease Background: Subclavian stenosis is an uncommon clinical condition associated with severe cardiovascular complications, usually presenting with claudication and subclavian steal syndrome. Here we describe the rare case of bilateral subclavian artery stenosis in an asymptomatic patient. Case Report: Our patient was a 63-year-old chronic smoker with no prior medical history whose chief complaint was dyspnea from an exacerbation of his chronic obstructive pulmonary disease (COPD). He was hypotensive with blood pressure 74/56 mmHg at admission, which raised suspicion for sepsis, adrenal insufficiency but the workup (renal panel, full blood count and synacthen tests) were normal. He quickly recovered after we treated his COPD exacerbation, but his hypotension persisted despite repeated fluid challenges. To evaluate for structural causes of his hypotension, we performed a full cardiovascular examination with 4 limb blood pressure measurements and found upper limb hypotension and lower limb hypertension. Subsequent imaging with ultrasound and computed tomography confirmed the presence of bilateral subclavian artery stenosis. Our diagnosis was thus bilateral subclavian artery stenosis secondary to atherosclerosis from chronic smoking. The patient was subsequently referred to vascular surgery for consideration of surgical revascularization. Conclusions: Bilateral subclavian stenosis is extremely rare and requires a high index of clinical suspicion. Early diagnosis is important in the primary prevention of associated cardiovascular diseases.

Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A (α-gal A). The clinical variability of the phenotypes of Fabry disease in females is still poorly understood. The degree of aberrant methylation of non-mutated alleles is thought to have significant effects on X-chromosome inactivation (XCI). We previously reported that one heterozygous Fabry female showing classical phenotypes had complete methylation of the non-mutated allele of the GLA gene. In this report, we summarized 36 heterozygous females with a clinical severity score based on the FAbry STabilization indEX (FASTEX). We measured their α-gal A activity and plasma/ serum globotriaosylsphingosine (lyso-Gb3) accumulation and performed electron microscopy of skin biopsies. We analyzed the methylation-sensitive restriction enzyme sites throughout the GLA gene, including the 5’UTR, and found a single SacII site and multiple HhaI and HpaII sites aggregated in exon 1 and the 5’UTR. One HpaII sequence in exon 7 was also detected as a methylation-sensitive site. With methylation-sensitive restriction enzymes, methylated and non-methylated alleles could be separated, and the ratio of the methylation was quantified. We found a clear correlation between the severity of the phenotype and lyso-Gb3 accumulation for heterozygous Fabry disease in females. Methylation of the non-mutated allele was also proportionately correlated to the clinical severity score measured by FASTEX., Highlights • We summarized 36 heterozygous Japanese Fabry females with their clinical severity score. • We had detected methylation-sensitive restriction enzyme sites in exon 7 along with exon 1 and 5`UTR. • A clear correlation of patients’ FASTEX scores, sphingolipids accumulations and dysmethylation of the GLA gene was detected.

Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune disorder of unknown etiology. The inflammatory stress in SLE patients may modify macromolecules and produce structural/functional abnormalities. The present study is aimed at examining the consequences of stresses on the structure of albumin in SLE patients. Albumin was isolated from the sera of SLE/healthy subjects. Multiple physicochemical techniques were used to elucidate, structure of albumin. Advanced glycation end products in SLE patients' albumin were identified by the AGE specific fluorescence. Quenching of tryptophan, tyrosine fluorescence and surface protein hydrophobicity was observed in SLE patients' albumin. Protein-bound carbonyls were elevated while free thiol, lysine, arginine, and alpha helicity was found to be decreased in SLE albumin. Furthermore, changes in the secondary structure of SLE albumin were observed as shift in the position of amide I/II bands. Functionality of SLE albumin was also compromised as its cobalt-binding ability was substantially declined. Adduction of moieties was detected by dynamic light scattering (DLS) and confirmed by matrix assisted laser desorption/ionization. DLS, thioflavin T and transmission electron microscopy results confirmed aggregates in SLE patients' albumin. This study may be helpful in understanding the role of modified albumin in the cofounding pathologies associated with SLE.

Background: The clinical spectrum of carotid atherosclerosis is well characterized, but the events leading to plaque instability and stroke are less understood. Evidence suggests that platelets serve as an interface among hemostasis, inflammation, and atherosclerosis. Coated-platelets, a subset of platelets with high procoagulant potential, are increased in asymptomatic carotid stenosis patients at high risk for stroke or TIA. We now examine the impact of other soluble mediators of inflammation, cell adhesion, angiogenesis and coagulation on the association between coated-platelets and TIA/stroke in asymptomatic carotid stenosis. Methods: Consecutive asymptomatic patients with ≥50% carotid stenosis were enrolled. Coated-platelet levels were assayed and plasma was obtained for measurement of 58 biomarkers. Patients were followed at 6-month intervals for intensive vascular risk reduction. Those with signs or symptoms of TIA/stroke underwent either brain CT or MRI. Rank order correlations between inflammatory marker concentrations, coated-platelet levels and TIA/stroke were determined using the Spearman correlation coefficient. Variables associated with TIA/stroke (p Results: We enrolled 117 patients (97% male, average age 71, 94% on statins, 96% on antiplatelets, and 33% currently smoking, average HgA1c 6.6% and average LDL 86 mg/dL). There were 6 strokes and 2 TIA’s ipsilateral to carotid stenosis during a mean 21.3 ± 6.7 months of follow-up (incidence of 3.89/100 person-years). Stepwise logistic regression identified TNF alpha (OR=11.1, p=0.0300) and coated-platelet group (OR=14.1, p=0.0167) as predictors of TIA/stroke ipsilateral to stenosis. Cox Proportional Hazard analysis yielded a TIA/stroke HR of 11.8 for the high coated-platelet group (95% CI 1.4, 96.1, p=0.0215) and 8.0 (95% CI 0.97, 66.3, p=0.0529) for the high TNF alpha group. Discussion: Coated-platelets and TNF alpha predict TIA/stroke in asymptomatic carotid stenosis at 21 months. These findings expand on our previous work in coated-platelets and asymptomatic carotid stenosis and suggest that coated-platelets may represent a common link between hemostatic and inflammatory mechanisms of plaque instability.

Objectives The WHO recommends inclusion of post‐exposure chemoprophylaxis with single‐dose rifampicin in national leprosy control programmes. The objective was to estimate the cost of leprosy services at primary care level in two different public‐health settings. Methods Ingredient‐based costing was performed in eight primary health centres (PHCs) purposively selected in the Union Territory of Dadra and Nagar Haveli (DNH) and the Umbergaon block of Valsad district, Gujarat, India. All costs were bootstrapped, and to estimate the variation in total cost under uncertainty, a univariate sensitivity analysis was performed. Results The mean annual cost of providing leprosy services was USD 29 072 in the DNH PHC (95% CI: 22 125–36 020) and USD 11 082 in Umbergaon (95% CI: 8334–13 830). The single largest cost component was human resources: 79% in DNH and 83% in Umbergaon. The unit cost for screening the contact of a leprosy patient was USD 1 in DNH (95% CI: 0.8–1.2) and USD 0.3 in Umbergaon (95% CI: 0.2–0.4). In DNH, the unit cost of delivering single‐dose of rifampicin (SDR) as chemoprophylaxis for contacts was USD 2.9 (95% CI: 2.5–3.7). Conclusions The setting with an enhanced public‐health financing system invests more in leprosy services than a setting with fewer financial resources. In terms of leprosy visits, the enhanced public‐health system is hardly more expensive than the non‐enhanced public‐health system. The unit cost of contact screening is not high, favouring its sustainability in the programme.

Introduction: A large number of Muslims fast during the holy month of Ramadan worldwide. A specific approach is needed to manage diabetic patients who intend to fast during Ramadan because of potential harm. Thus, the study aimed to describe the sociodemography and the characteristic of fasting diabetic patients admitted due to acute diabetic complications during Ramadan. Materials and Methods: A cross-sectional study was conducted among fasting diabetic patients in Hospital Tengku Ampuan Afzan (HTAA) who were admitted due to severe hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome and uncontrolled diabetes mellitus during the month of Ramadan 2017/1438H. Subjects were interviewed and blood investigation results were obtained from medical records and recorded in patients' case report. Results: Thirteen patients who were admitted due to acute complications of diabetics during Ramadan were included in this study. Of these, 38.5% had severe hypoglycemia, 23.1% diabetic ketoacidosis, 15.4% hyperglycemia hyperosmolar syndrome and 23.1% uncontrolled diabetes mellitus. All of the patients had a long standing diabetes mellitus (median duration of 10 years). HbA1C was high (11.5%) among hyperglycemic subjects. Types of treatment and previous history of severe hypoglycemia prior to Ramadan were the only independent factors identified to be related with acute complications of diabetes during fasting month (p=0.030 and p=0.032 respectively). Insulin, either alone or in combination with oral hypoglycemic agent, was associated with higher number of hypoglycemic event. Conclusion: The significant risk factors found were consistent with other studies. A thorough, individualized and holistic approach is needed in managing patients with diabetes who intend to fast.

Hypocalcaemic tetany is one the commonest complication after total thyroidectomy. It may cause significant morbidity. Early detection and treatment have better out come. The main objective of the study is to find the incidence of hypcalcaemic tetany in post operative period after total thyroidectomy and average interval period of hypocalcaemia following surgery. This was an observational study conducted in the department of Otolaryngology & head-Neck Surgery Sylhet M.A.G. Osmani Medical College Hospital during 1st January 2006 to 31st December 2007. Pre-operative routine investigation, Thyroid Function test, Ultrasonography thyroid gland and cytological evaluation by FNAC were done in all patients. Ten patient developed hypocalcaemia after surgery. Among them only one suffered from permanent hypocalcaemia. Most of the patient developed symptoms about 48 hours after surgery. The Incidence and time interval of development of hypocalcaemic tetany after total thyroidectomy found in the series fully coincides with the results of other researchers globally.Faridpur Med. Coll. J. Jul 2015;10(2): 59-62

Tumoral calcinosis is a rare diagnosis characterized by deposition of calcium salts in peri-articular soft tissue regions. It is divided into primary and secondary varieties. The primary tumoral calcinosis is further divided into two types; primary hyperphosphatemic type and primary normophosphatemic type. The secondary variety occurs in association with chronic renal failure. Biochemical assessment and typical radiographic features help in diagnosis. Mainstay of treatment for primary variety is surgical. Secondary variety is mainly treated by medical measures. Surgical intervention is reserved for patients who do not respond to medical therapy.

Background: Patients with liver disorders are often found to have deranged lipid profile. Clear decline is observed in the levels of cholesterol as well as TG among individuals having severe hepatitis and liver failure as synthesis of lipoprotein is reduced. This study was done to determine the frequency of dyslipidemia and the mean lipid profile values in patients of liver cirrhosis.Methods: A cross sectional, descriptive study, done at the Department of Medicine, Medical Unit-1, Bahawal Victoria Hospital, Bahawalpur, from July to December 2019. A total of 246 patients presented with cirrhosis of liver of age 20-60 years and both genders were included. Analysis for serum total cholesterol (TC) level, serum triglycerides level, low density lipoprotein (LDL) and high density lipoprotein (HDL) were done and findings were noted.Results: Mean age was 51.67±6.21 years. Out of the 246 patients, 153 (62.20%) were male and 93 (37.80%) were females with male to female ratio of 1.6:1. Mean values of lipid were, LDL cholesterol 95.76±29.65 mg/dl, HDL 43.37±11.46 mg/dl, TC 147.51±42.69 mg/dl and TG 101.29±21.59 mg/dl. Dyslipidemia was found in 59 (23.98%) patients, whereas there was no dyslipidemia in 187 (76.02%) patients.Conclusions: Frequency of dyslipidemia in cirrhotic patients is high. Evaluating patients of liver cirrhosis, dyslipidemia need to be considered for early recognition and analysis.

Background Pompe disease is an autosomal recessive glycogen storage disorder caused by a deficiency of the lysosomal glycogen-hydrolyzing enzyme acid α-glucosidase. The adult-onset form, late-onset Pompe disease, has been characterized by glycogen accumulation, primarily in skeletal and smooth muscles, causing weakness of the proximal limb girdle and respiratory compromises. Case Report A 59-year-old female was admitted to the hospital with acute cerebral stroke at the age of 57years. Following her admission, conventional conservative stroke management followed by cerebral arterial clipping was performed. However, weakness of lower extremities, predominantly in the right side, and evening headache were persisting. After obtaining a careful past history, she noticed that she had a history of recurrent respiratory tract infection and she did not like any physical exercise in school. She also complained of gait disturbance since 32years of age. She had also been suffering from systemic hypertension since 40years of age. She had mild respiratory and swallowing difficulties. Her brain Magnetic Resonance (MR) revealed multiple infractions and white matter degeneration with irregular basilar arterial walls. A computed tomography (CT) scan of lower extremities showed diffuse fibrosis of the proximal muscles predominantly on the right thigh. Cardiac echocardiogram showed left ventricular hypertrophy. Electron microscopy of blood cells including lymphocytes and platelets and skin fibroblasts showed marked granular inclusions in lysosomes, suggesting glycogen accumulation. Her measured acid α-glucosidase activity was very low, 1.3 pmol hour−1 punch−1, and we found a homozygous splice-site mutation c.546G>T in the GAA gene. Conclusion Cerebral stoke as an initial finding for an adult-type Pompe disease is rare. Left ventricular hypertrophy is also rarely reported for adult onset of Pompe disease. This case will explore further ways to diagnose adult-onset Pompe disease.