Postoperative pain management of cesarean patients has become a major medical and nursing challenge in all over the world. Due to the various constraints postoperative pain management of cesarean patient in Bangladesh got greater attention from the scientific community and policy makers. An observational study was conducted to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing cesarean section in the obstetric unit in a district hospital, Hobigonj, Bangladesh during the period from February 2022 to August 2022. We recorded patient’s demographics, postoperative pain orders, and analgesia regime on the day of surgery. Anesthesia team, which included one of the investigators, assessed the overall pain since the time of surgery by visual analogue scale (VAS) and also recorded any complications since the time of surgery and patients’ satisfaction with the pain management. A total of 150 patients were reviewed during the study period. The common modality of pain management was intravenous opioid infusion (94%) and co-analgesia was used in 99% of patients. The analysis of pain at rest by VAS was between 1 and 3 in 89.7%, 4 and 6 in 9.5%, and 7 and 10 in 0.8% of patients. The VAS on movement was 1–3 in 60.1%, 4–6 in 33.1%, and 7–10 in 6.8% of patients. Patients’ opinion regarding postoperative pain management was satisfactory in 76.60% of patients and unsatisfactory in 23.40% of patients. In the conclusion, we can say, the regime for postoperative pain management was mostly started and followed by both the teams at the hospital and was not adequately satisfied.

This paper provides an overview of the development of Lu Shuyuan’s spiritual ecology theory and explains the key concepts of the theory.

Crimean-Congo hemorrhagic fever (CCHF) is a condition brought on by a virus (Nairovirus) that is spread by ticks and is a member of the Bunyaviridae family and the genus Hayalomma. This virus could travel across the Hayaloma genus. This species maintains two host-life cycles, changing from a larva to a nymph on its first host, which can be a tiny animal like a bird, and then from adult stages to humans, which serve as the second host. Currently, 27 distinct Hyalomma species are recognized. Geographically, CCHFV is spread throughout Asia, the Middle East, Southern Europe, and Africa, all of which have large tick populations. This virus is capable of spreading both horizontally and vertically. Animals like sheep, goats, cattle, and hares may act as hosts or reservoirs for the virus. Humans can contract this virus by coming into touch with infected ticks or animal blood. Due to contact with bodily fluids or infectious blood, medical personnel are most vulnerable in endemic areas. This virus can cause symptoms such as high fever, joint discomfort, headache, back pain, vomiting, and stomach pain in infected individuals. To identify this virus, scientists employ the ELISA and RT-PCR methods. The medicine ribavirin and some readily available vaccinations can also be used to treat this virus. The effectiveness of using the vaccines and medications that are now available to treat this virus cannot be proven. The effectiveness of the vaccine to protect against this virus was investigated using a small animal model, such as a knockout mouse.

Background: Systemic lupus erythematosus is characterized by a wide range of symptoms, and hematological abnormalities are a typical complication (SLE). There are some that are immediately life-threatening and need immediate attention, and then there are those that require more careful thought. Objective: The purpose of this research was to better understand the hematological symptoms experienced by people with SLE. Method: This cross sectional study was carried out at tertiary hospital, Bangladesh from January 2021 to October 2022. Where a total of 100 Patients of SLE as diagnosed according to American college of Rheumatology (ACR) criteria were included in the study and patients with hematological problems for due to other diseases were excluded. Results: During the study, 21-25 years age group, 30% and 90% were female. Most common presenting complaints were arthralgia (82%) followed by malar rash(70%) and myalgia (66%). 25% had hypertension, 16% had autoimmune thyroids, 5% had DM, 40% had no history of previous. 80%were taken sterios, followed by 30% were taken Mycophenolate Mofetil, 25% were taken Cyclophosphamide, 9% were taken Methotrexate. In addition to that, Anemia was the most common hematological abnormality detected in 70% patients. Normocytic normochromic anemia (NNA) was the most common peripheral blood film (PBF) findings found in 36% of the patients followed by microcytic hypochromicanemia (MHA) 30%. A positive direct Coomb’s test was found in 40% of the patients and antiphospholipid antibody (APLA) was positive in 20% of the patients. Conclusion: Patients with SLE often have haematological abnormalities. Differentiating haematological abnormalities as a symptom of SLE, a side effect of SLE therapy, or part of another blood dyscrasia is essential.

الحمد لله القائل{ ليميز الله الخبيث من الطيب} والقائل: {إن الحسنات يذهبن السيئات} والصلاة والصلام على أفصح العرب نطقًا بالضاد القائل: "إن نقدت الناس نقدوك فإن تركتهم تركوك" وعلى آله وأصحابه غر الميامين ومن نهج نهجهم إلى يوم الدين،

Aim: To compare and contrast the shear bond strength and adhesive remnant index scores of different Self ligating brackets. Materials and methods: A total of 75 extracted human first premolars were selected and divided into 3 groups of 25 for each bracket system. Each sample was then embedded in an acrylic block, till the coronal portion. Instron testing machine model LR LOYD 50 K was used for testing the shear bond strength. SBS values and adhesive failure rates were recorded. Results: All the bracket systems considered in the study demonstrated and clinically adequate Shear bond strength. Among the three groups, Damon Q gave the least remnant index score followed by SmartClip and BioQuick. Conclusion: The highest bond strength and the least remnant index score were obtained from Damon Q system, followed by Smartclip and BioQuick in the same order.

Objectives: Competency based clinical training in most of the dental schools in Saudi Arabia incorporates a clear rubrics for evaluation of clinical procedure where use of rubber dam is one of the criteria to be effectively fulfilled by the students. The present study aims to determine the knowledge, attitude and practice towards the use of rubber dam by dental students and interns of various dental schools in Saudi Arabia. Methodology: A cross-sectional study was conducted among the dental students of various Saudi university through google form during January 2022 to March 2022. A pretested questionnaire in a 5 point Likert scale ranging from strongly agree (score 5) to strongly disagree (score 1) containing three sections (each containing 10 questions) to measure knowledge, attitude and practice towards use of rubber dam was used. The questionnaire for barriers for rubber dam use included 5 items. The Chi-square test and One-way ANOVA followed by Tukey post hoc was used to compare the responses between the male and female students and dental students of difference academic levels. Results: Total of 273 valid responses were received (189 (69.23%) male and 84 (30.77%) female). The overall average Likert score for knowledge about rubber dam among dental students was 3.45 (± 1.2). The overall average Likert score for questionnaire items assessing attitude of dental students about rubber dam was 3.81 (± 0.9). The respective overall average score for male and female dental students for their attitude towards rubber dam was 3.32 (±0.8) and 4.30 (±0.11) with p = 0.04. The overall average Likert score for practice items was 3.73 (±0.8)(Table 4,Fig-2). The respective overall average score for male and female dental students for practice of rubber dam was 3.13 (±1.1) and 4.33 (±0.8) with p = 0.03. For the questionnaire items assessing the barriers for using rubber dam, the average score for unavailability of suitable rubber dam clamp and patient refuse both scored 4.3. Conclusion: The finding suggest that the dental students have adequate knowledge and training for rubber dam use. The attitude and practice towards consistent use of rubber dam should be reinforced through proper motivation. A future research with a larger sample size and patients feedback on rubber dam will be helpful.

Background: Traditional oral examination is a subjective tool of assessment, day by day which is losing its credibility because lack of its objectivity and impartiality. On the other hand, Structured Oral Examination (SOE) is a modified form of oral examination with some criteria where whole system is structured beforehand by preparing the questions in advance covering the educational objectives, carefully selecting the examiner, equal time allocated for each examinee & concurrent marking for each response. Structured Oral Examination (SOE) may be considered as the appropriate concept to overcome the drawbacks of the traditional oral examination but its implementation is a tedious, keen, time-consuming job. Aim of the Study: The aim of this study- to sought out suggestions of medical teachers in overcoming the problems in practicing SOE. Methods: This descriptive cross sectional qualitative study was conducted in two public and two private medical colleges, namely Dhaka Medical College, Sir Salimullah Medical College, Ibrahim Medical College and Holy Family Red Crescent Medical College in Bangladesh during the period from July 2010-June 2011. The MBBS course was then divided into 3 phases. In total 50 teachers who were conducting Structured Oral Examinations (SOE) for at least last two years in any of selected medical colleges were enrolled as the study subjects. An open-ended questionnaire was used to collect research data. Data were edited after collection. Then the content was analyzed by the researcher and has been presented in a narrative form and also quantification of these data shown separately for convenience. Results: Lack of proper teacher training & motivation, lack of uniformity in examination process in different medical colleges were common problem faced uniformly by all (100%). Inadequate number & remuneration of teachers, undue intervention of authority/political leaders/influential/co-examiner, chance of leakage of ill prepared & inadequate number of questions were other important problems & drawbacks in the opinion of 3/4th (74%) of the respondents. Above-all preparing well-structured SOE question card is a tedious & time-consuming procedure to all (100%) teachers. The ultimate recommendations of our teachers to overcome these were, regular & continuous training of teachers on assessment, central question bank & central monitoring & moderation of question for all medical colleges, appointment of post graduate doctor of same discipline in registrar or in equivalent post who are directly related to teaching & assessment were uniform opinion of all (100%) teachers. Other recommendations include number of competent teachers & remuneration of teachers should be increased - opinion of 3/4th (74%) of the respondents, separate medical education service so only motivated doctors can be selected in teaching profession, enforcing some strict regulatory laws, judicious setup/pairing of examiner, some (20%) open ended questions may be included in all question card for giving extra marks to extra ordinary student or for assessing exact level of learning in case of very poor performed student, rearrangement of subjects in different Phases to overcome time constraint, final examination may be conducted by separate medical college in separate venue. Conclusion: As per the findings of this study we can conclude that, considering the scholar opinion of medical teachers if their recommendations can be implemented, undoubtedly our medical education will progress further by certifying more competent and safer doctor for ourselves and universe.

Background: Cabergoline is effective in the treatment of hyperprolactinemic hypogonadism. It is a highly effective and long-acting inhibitor of prolactin secretion. The rate of cabergoline-induced pregnancy in women with prolactinoma, is unknown. Objective: The aim of present study is to evaluate the efficacy and safety of high-dose cabergoline therapy for hyperprolactinemic infertility among Bangladeshi women. Method: This descriptive cross- sectional study was conducted among 50 patients from January, 2020 to January, 2022 in at The Medinova Diagnostic Centre, Sylhet, Bangladesh. Results: In our study, maximum (14) patients belong to the age group of 19 to 23 years, and minimum number of patients (4) was between 39 to 43 years. Maximum (52%) patients had the primary infertility and 48% had secondary infertility. The mean values of thyroid stimulating hormone (TSH), Follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin PRL is 3.93±6.58, 10.96±13.58, 9.83±6.8, and 12.46±14.39 respectively and these were significant. 12% patients had PCO and 88% patients were normal in our study. 78% semens were normal, 4% semen showed Azzospermia, 14% semens showed Oligo Astheno Spine and 4% semens showed Astheno spine. Conclusion: In infertile women with prolactinoma, cabergoline can achieve a high pregnancy rate with uneventful outcomes. The findings demonstrated that cabergoline can be used safely to improve menstrual cycles in hyperprolactinemia.

Polycystic liver disease is an autosomal dominant disorder, rare and benign in the majority of cases [1]. It is frequently associated with polycystic kidney disease, but can also be isolated in rare cases. Liver cysts result from abnormal growth of the biliary epithelium (cholangiocytes) or dilation of the peribiliary glands, due to the persistence of embryonic biliary structures. Isolated polycystic liver disease is generally asymptomatic, women are more affected than men and also have a greater number of cysts [2]. We report the case of a 40-year-old asymptomatic man with isolated polycystic liver disease Gigot III discovered during a health check-up. The clinical examination showed hepatomegaly without pain, of firm consistency, smooth surface, sharp lower edge with a hepatic arrow at 17cm. The kidneys are devoid of cysts, the liver function as well as the renal function are normal.

Background: Caesarean section is one of the common surgical interventions to save lives of the mothers and/or the newborns. However there is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. Due to a limited literature regarding this topic in the Indian scenario, the present study was done to assess the predisposing factors, indications of second stage caesarean section and its fetomaternal outcome. Material and Methods: In Present descriptive longitudinal study 211 patient’s undergone caesarean sections at full cervical dilatation were included as per inclusion and exclusion criteria. A pilot study was done for validation, practicality and applicability of questionnaire. Results: In present study most cases were in the age group of 26 to 30 years (38.38%). The most common indication for emergency second stage caesarean section was non-progression of labour followed by obstructed labour. Atopic PPH, hematuria was the commonest intraoperative complications while pyrexia, prolong catheterization was the predominant post-operative complications NICU admission needed for 16.11% babies due to birth asphyxia and respiratory distress. Conclusions: Caesarean section in the 2nd stage of labor is associated with maternal and neonatal morbidity and mortality. These factors needs to be anticipated to reduce mortality and morbidity associated with it. A proper judgment is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

The fact that blood groups can act as receptors/coreceptors for bacteria, viruses, and parasites demonstrates the importance of blood groups in infection. Blood group antigens also aid in cell adsorption, signal transmission, and/or membrane micro-domain retention. Furthermore, blood type can influence the innate immune response to infection. This data was compiled using the risk perception of blood transfusion scale, which is part of a larger risk perception questionnaire. Blood transfusion risk perception is measured on a 7-point Likert scale based on a set of qualitative characteristics; 119 participants in Hafr Al-Batin blood bank had a significant difference in risk perception of blood transfusion due to receiving blood, whereas those who had never received blood had no risk perception. as much risk perception of blood transfusion, and because of viral hepatitis infection, those who did not have viral hepatitis had more risk perception of blood transfusion, but there is no significant difference in risk perception of blood transfusion due to gender, age, educational level, and blood donation. The implementation of strict donor pre-screening and preventative measures to control infections in the general population, as well as the introduction of new, more sensitive screening tests, could significantly reduce transfusion-transmitted viral infections across eastern Saudi Arabia.

This paper analyzes the causes of the spiritual imbalance of the female characters Caddy, Mrs Compson and Dilsey in The Sound and the Fury from three aspects, namely ideological restriction, alienated existence and spiritual wasteland.

Introduction: Pregnancy is a physiological process. Preeclampsia is the commonest complication during pregnancy. This condition might severely affect the health of mothers and their newborns. Newborn of mothers with preeclampsia are more liable for intrauterine growth retardation and may be delivered prematurely. Aim of the Study: The aim of this study was to evaluate the platelet count and mean platelet volume in newborn of preeclamptic mother. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood was collected from each newborn after delivery and was analyzed for Platelet count and mean platelet volume. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre- designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: The mean (± SD) platelet count was 164.77 ± 79.44 × 103/µl and 212.83 ± 54.04 ×103/µl in group A and B respectively. In this study, the mean (±SD) platelet count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). The mean (± SD) platelet volume was 8.90±1.15 fl and 8.30±1.45 fl in group A and B respectively. In this study, the mean (±SD) platelet volume was higher in group A in comparison to that of group B which was not statistically significant. Maternal systolic blood pressure showed negative correlation (- 0.952) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (- 0.960) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (-0.973) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Maternal diastolic blood pressure showed negative correlation (-0.964) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Conclusion: From the findings of the study, it can be concluded that the platelet count of newborn of preeclamptic mother was significantly lower in comparison to newborn of healthy pregnant mother but they were within normal range. This difference was significantly related to severity of maternal blood pressure. But there was no statistically significant difference in mean platelet volume between the groups. There was no statistically significant relation of mean platelet volume to maternal blood pressure.

Background: Although ticagrelor is more potent than clopidogrel, it is associated with higher risk of bleeding and dyspnea. Since elderly patients are at higher risk of bleeding there is a concern of whether they should be prescribed clopidogrel instead of ticagrelor and a shorter duration of DAPT or even a monotherapy antiplatelet. Additionally, guidelines recommend being cautious when prescribing ticagrelor to COPD and asthmatic patients, yet, it is unclear whether patients with respiratory conditions are at higher risk of dyspnea from ticagrelor. This scooping review is conducted to assess the safety and efficacy of ticagrelor versus clopidogrel in elderly ≥75 years and patients with respiratory conditions. Also, to investigate the most suitable antiplatelet duration for elderly patients ≥75 years. Method: EMBASE, MEDLINE, and Cochran library were systemically searched. Studies were included if they were published in English; included adult patients diagnosed with ACS; are ≥75 years old or diagnosed with respiratory disease (asthma, COPD); treated with DAPT including clopidogrel or ticagrelor or monotherapy antiplatelet; reported quantitative data regarding bleeding or dyspnea. Studies were excluded if they were published prior to 2006. Outcome of interest were cardiovascular events, bleeding, and dyspnea. Results: 13 articles met the inclusion criteria and were included: 5 RCTs, 1 non-RCT, and 7 subgroup analyses. Two studies compared the safety and efficacy of ticagrelor versus clopidogrel in COPD patients (one of the studies included asthmatic patients), 3 studies compared safety and efficacy of ticagrelor versus clopidogrel in elderly, and 8 studies compared the duration of DAPT in elderly. Conclusions: Available data suggests that COPD and asthmatic patients are not at higher risk of dyspnea from ticagrelor and might benefit more from ticagrelor since they are at higher risk of ischemic events, yet, it is associated with higher discontinuation rate. Additionally, there was no difference between clopidogrel and ticagrelor in elderly patients in regard to cardiovascular endpoint while clopidogrel might lower the risk of bleeding. Shorter duration of DAPT might also minimize the risk of bleeding in elderly. However, data regarding DAPT in elderly and respiratory disease patients is limited, and evidence regarding the most appropriate regimen remains inconclusive.