Primary hyperoxaluria type 1 (PH1) is a rare disorder of glyoxylate metabolism, characterized by an excess of oxalate. Renal manifestations can range from occasional kidney stones, nephrolithiasis and recurrent nephrocalcinosis to end-stage renal disease (ESRD) and systemic oxalosis. We report the case of a 32-year-old man, referred to our department for the management of bone pain. His parents were first degree cousins. The patient had a history of recurrent urolithiasis whose spectrophotometric study revealed an oxalocalcic lithiasis. He was on chronic hemodialysis program for the last 4 years with a presumed diagnosis of ESRD due to tubulo intersticiel nephropathy. He had diffuse bone pain for the last 8 months, more and more disabling and deforming. Clinical examination found bone signs such as thoracic deformity, bone pain on the palpation of the large joints and spine, waddling walk, hepatosplenomegaly and livedo reticularis. The assessment objectified multiple vertebral and sacroiliac osteolytic lesions and total cortical calcifications of both kidneys, normochromic anemia at 7.7 g / dl with a ferritinemia at 1194, inflammatory syndrome with C reactive protein (CRP) at 50 mg/l, normal calcemia at 90 mg / l, hypoparathyroidism at 105 μg /ml, hypothyroidism and bone biopsy revealed deposit of calcium oxalate crystals and crystal granulomas. In front of the consanguinity field, oxalocalcic repetitive lithiasis, nephrocalcinosis and the organic infiltration diffused by oxalate crystals, we concluded to systemic oxalosis. Pyridoxine hydrochloride treatment was combined to depleting dialysis while waiting for a potential liver and kidney donor.

Choice of glucocorticoids alongside its dose and duration are the significant angles which should be thought of while prescribing to the critically ill hospitalized patients. The reason for this examination was to get information on the current prescribing pattern of Glucocorticoids in-understanding at a tertiary care teaching hospital with an extreme objective to advance fitting utilization of glucocorticoid. An observational investigation, directed for a time of a half year from September 2019 to February 2020 in Navodaya Medical College, Hospital and Research Center (NMCH&RC) Raichur. The current investigation was done in patients old enough 18 or above and of either sex who were endorsed with Glucocorticoid. All the new cases with glucocorticoid given was taken for the examination. Patients who were under 18, ICU patients, lactating and pregnant ladies were prohibited from the examination. All the gathered information was dissected with the assistance of standard rules. In the current examination, the recommendation of glucocorticoids is discovered to be proper around 78 %. Nonetheless, to guarantee protected, compelling, and even helpful administration with glucocorticoids, the two patients and prescribers should be more mindful of the fitting portion, measurement routine, course of organization, the span of treatment and generally speaking rules for glucocorticoids recommending. Subsequently the inclusion of clinical drug specialists in clinical practice assists with expanding appropriate utilization of glucocorticoids and ideal result.

In current scenario transdermal delivery of bioactive molecules has become an interesting research area. Transdermal delivery enables direct entry of bioactive molecules into systemic circulation, bypass of hepatic metabolism, improves patient compliance, and low risk of injury to the tissues. Though it is one of the attractive routes, transport of drug through the skin has remained a challenge. To overcome the challenge, vesicular system has been adopted so as to have better skin permeation of bioactive agents. Vesicular system like liposome has shown inefficiency to cross the layers of skin. To overcome this hurdle a novel vesicular & non-invasive drug delivery system Nanoethosomes was developed. Nanoethosomes are used for deeper permeation of bioactive molecules. The main components are phospholipids, ethanol, and water. Presence of high amount of ethanol in their structure differentiates them from other vesicular systems and also helps to release encapsulated material into basal skin layer and blood circulation. Ethanol gives a net negative charge on vesicle surface promoting its size reduction. Vesicular system gives a better patient compliance, being a non-invasive method of drug administration. In this review article we are going to see brief information about methods of preparation, characterization and pharmaceutical uses of Nanoethosomes.

Background: Bleeding is a common side effect during anticoagulant therapy. Rivaroxaban, a new anticoagulant, presents concerns regarding its association with heavy menstrual bleeding. Objectives: Our aim is to measure the prevalence of heavy menstrual bleeding in women taking rivaroxaban. We aim to measure the median Pictorial Blood Assessment Chart (PBAC) score, and its association with iron deficiency anemia (IDA), passage of clots, and age, respectively. Methods: This was a prospective, non- interventional study set in a thrombosis clinic. There were 49 patients enrolled. The study consisted of two parts: a retrospective part regarding collection of menstrual history data before starting rivaroxaban; and a prospective part using validate Arabic PBAC for the next three menstrual cycles. Main outcome measures: Prevalence of heavy menstrual bleeding among women taking rivaroxaban. Results: The median PBAC score for women taking rivaroxaban for an average of 3 months was 211, IQR (42.5, 375.9) The prevalence of heavy menstrual bleeding in women taking rivaroxaban was 22%. There is a weak correlation between IDA and age, and IDA and average PBAC score. Conclusion: Rivaroxaban may cause heavy menstrual bleeding, but it does not lead to prolongation of menstruation. A detailed menstrual history should be taken before considering rivaroxaban for women in reproductive age.

Pain in the knee joint has become one of the most common pathologies that are affecting humans of all age groups in the modern world. Many of the arthropathies are resolved with supportive care and complete tests but some of the diseases require early diagnosis and prompt treatment to prevent any long time effects. Doppler ultrasonography has revolutionized our way of approaching these diseases. It has several advantages over other imaging techniques. It is non-invasive and there is no use of a contrast dye which permits us to use this technique even in those patients who are hyper allergic. There is no use of radiations in ultrasonography. It can detect various minor abnormalities like cartilage thinning, partial or complete tears, synovial joints, abnormalities in the bony structure, inflammation debris in the joint, hematoma, and any ligamentous injury. It also helps us in the localization of the injury which further assist us in several aspects, one of which being the administration of the drugs with the help of an injection at the most optimal site.

Aim: To evaluate the efficacy of amniotic membrane transplantation in corneal ulcers and to observe the complications of amniotic membrane transplantation in corneal ulcers. Material and methods: Ours was a prospective cross- sectional study which was conducted over a period of 1 year at Regional Institute of Ophthalmology, PGIMS, Rohtak on 30 patients of microbial keratitis on whom amniotic membrane transplantation was done. Signs of ulcer healing- pain, congestion, size of ulcer, BCVA, anterior chamber depth and anterior chamber reaction were recorded on every subsequent follow up. Result: There was significant reduction in post-operative pain and congestion. Anterior chamber depth was not changed significantly. Conclusion: Amniotic membrane transplantation can be used as an adjuvant treatment in bacterial and fungal corneal ulcers for early healing, less vascularisation and scarring and better final visual outcome.

Background: Enteric fever is a common public health problem in Bangladesh and it involves multiple symptoms. Enteric fever presents with variable clinical scenario. Objective: The aim of study was to evaluate the clinical spectrum of enteric fever in children. Methods: A prospective study was done in the department of Paediatrics, Sylhet Womens Medical College Hospital and Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh during the period from January 2019 to December 2019 who was clinically suspected to have enteric fever and had either a positive blood culture for Salmonella or a positive Widal test. Results: This study included 133 patients out of which 71 were males and 62 were females. The majority of patients were under 5 years. The age distribution of study population in depicted and the sex distribution. The most common presenting symptoms in our study was fever (97.0%), abdominal pain (39.8%), vomiting (39.1%), diarrohea (36.1%), and the common symptom was constipation (18.8%) as depicted in table III. The most common physical findings was coated tongue (74.4%), followed by toxic look (63.9%), pallor (51.9%), abdominal distension (15.0%), abdominal tenderness (13.5%), Rose spots (14.3%), hepatomegaly (16.5%), splenomeagly (3.8%), and jaundice (4.5%) as depicted in Figure-1. Complications were present in nine patients (6.77%), Pneumonia was present in five patients (3.76%), hepatitis in three patents (2.25%) and encephalopathy in the patient (0.75%). Conclusions: Enteric fever is a common public health problem with fever as most common presenting symptom. Culture yield can be increased in enteric fever by drawing blood culture prior to administration of antibiotics. Ceftriaxone is highly efficacious as monotherapy in enteric fever.

The post-traumatic right diaphragmatic hernia associated with liver dislocation often goes unnoticed because it complicates violent trauma, but most times remains asymptomatic. It is recommended discussing systematically the diagnostic in case of closed abdominal chest trauma or after a bladed weapon wound in order to prevent its serious complications. We report two cases of post-traumatic diaphragmatic hernia associated with a liver luxation compiled in our service.

Skin Pigmentation is a phenomenon in which the accumulation of melanin occurs due to various factors and leads to skin tanning and other skin disorders. Now a day’s human beings are more conscious about quality of life and appearance. With this fascination towards various skin whitening or glowing agents is gaining more adherences. While synthetic chemicals approved as skin whitening agents have got the due recognition in market, the possible adverse effects on sensitive skin creates a question regarding their use. The natural plant extracts available as tyrosinase inhibitors are mostly phenolic entities. In this review the inhibitory effect of phenolic compound and flavonoids on tyrosinase enzyme using molecular simulations is studied. The insilico study of flavonoids helps to predict the mechanism of inhibition as well as identification of potential natural tyrosinase inhibitors. This review is oriented to understand the tyrosinase inhibitory activity of an array of phenolic compounds with emphasis on flavonoids to explain how position of the substituents and their interaction with the enzyme can be correlated for the efficacy against the tyrosinase activity.

Background: A major challenge to antiretroviral therapy is poor adherence by the patients due to the multiplicity of drugs involved. For effective outcome of therapy, a 95% adherence is advocated in patients on ARV drugs. Objectives: Study sought to evaluate the factors that affect the adherence to their prescribed medications by people living with HIV (PLWHIV) in the capital city of Port Harcourt, South-South, Nigeria. Methods: A descriptive cross sectional study using pretested questionnaire was used to collect information on adherence among HIV adult patients. Socio-demographic factors were evaluated as possible factors associated with adherence. Reasons for missing medications were also obtained and described. Results: Participants comprised of 109 (31.8%) males and 231 (67.3%) females (mean age 37.3 ± 8.9) years. Study revealed a poor level (58%) of adherence among participants. Patient factors (forgetfulness, personal travels and work schedule), were major reasons given for missing their medications. Others are economic (lack of transport, poverty) and socio-cultural (stigma, spiritual) factors. Social support in the form of treatment supporter was found to be a significant (p<0.05) positive influencing factor to adherence by patients as well as disclosure of status to spouse. Conclusion: Strategies to improve adherence should be focused on the ways to address the negative influencing factors. Improved awareness in terms of counselling, education and orientation of the patients is strongly advocated. Social support systems (family, community, treatment supporter) and societal acceptance of PLWHIV should be put in place to encourage adherence.