Introduction: Supracondylar fracture of the humerus is the most common fracture of the elbow in children and displacement is common. Main problem regarding management of early supracondylar fracture are obtaining and maintaining reduction as they commonly present in the emergency department with varying degrees of soft tissue swelling. Objective: To assess the Clinical and Radiological Outcome Type III Closed Supracondylar Fracture Of Humerus in Children treatment by percutaneous K-wires fixation. Methods: This study was carried out at the NITOR, over a period of 24 months between January 2015 to December 2016. The total number of patients were 30. All patients suffering from closed supracondylar fracture of humerus in children. Each Gartland type-III closed Supracondylar Fracture of humerus among supracondylar Fracture in children attended at emergency, outpatient department and admitted in NITOR. Results: A total number of 30 patients were enrolled in this study as per inclusion and exclusion criteria. Diagnosis of the supracondylar fracture of humerus was made by history, clinical examination and radiological evidence. The youngest patient in our series is 3 years old and the oldest is 12 years. Majority were in 5-8years. Among 30 patients mean age was 6.85 years with SD = ± 2.37 years. In the present series, maximum patients were male 22 (73.3%) and 8 (26.7%) patients were female. Male female ratio 2.75:1. Male patients were predominant in this study. The results are shown in table-I. In the present series, 19 (63.3%) with left sided supracondylar fracture of humerus and 11(36.7%) presented with right sided supacondylar fracture of humerus. The results are shown in Table-II. Out of 30 cases 15 (50%) cases gave history of fall from tree, 6(20%) cases gave history of fall from bed, 4(13.3%) cases gave history of fall during playing, 5(16.7%) cases gave history of RTA due to fall from bicycle. In the present series, postero-medial fracture was found in 18(60.0%) cases and postero-lateral fracture in 12 (40.0%) cases. Out of 30 patient’s about 16 (53.3%) of the patient’s was operated between (13-18) hours of receiving injury, 11 (36.7%) with in (7-12) hours and 1 (3.3%) within (0-6) hours of injury and 2(6.7%) with in (19-24) hours of injury, mean interval between injury and Operation was 8.06 ± 5.52 hours. Out of 30 patient’s, 22 (73.3%) of the patients stayed in the hospital for 1 day and 8 (26.7%) of the patients stayed in the hospital for 2 days. The mean duration of hospital stay was 1.26 ± 0.45 days. In this series, among 30 Patients, 27(90.0%) had radiologically sufficient callus formation and 3(10.0%) patients had no sufficient callus formation. Functional outcome was satisfactory result (Excellent, Good and Fair) were 27(90.0%) and unsatisfactory result (poor) was 3 (10.0%). Conclusion: Finally, the result shows that in Gartland type-III closed supracondylar fracture of the humerus, closed reduction and stabilization by two lateral parallel percutaneous 'K'-wires is the good method for treatment.

Background and Objectives: Endoscopic myotomy is a recent technique that did spread quickly across high-income countries. The aim of this study is to report the experience of our department regarding the practice of POEM. Study design: It is a retrospective study including 13 patients with achalasia treated by POEM at the Department of Digestive Functional Explorations (EFD-HGE) of University Hospital Center Ibn Sina of Rabat, between January 2017 and June 2023. There was a break during the COVID19 pandemic and the endoscopic activity was stopped for a while. Results: The median age was 40, 46. Women were more affected than men: 69% and 31% respectively. Only 15% of cases had previous treatment (pneumatic dilation/surgical myotomy). The clinical success rate reached 84.6%. The mean of Eckardt scores decreased from 8 at baseline to 3 at 2 months. The IRP’s mean decreased from 23.9 mmHg to 15.6 mmHg after the gesture. The post-POEM reflux rate was less than 16%, but the rate of serious adverse events was relatively high. Conclusions: POEM is an effective procedure to treat achalasia with a low morbidity, provided that it is carried out in an expert center with suitable and good quality material.

Background/Objectives: Obesity has surged globally, posing various health risks. Its prevalence and management, especially in primary health care settings in Saudi Arabia, have recently been under the spotlight. This research synthesized various studies, analyzing the knowledge and preparedness of primary health care physicians in addressing and management of obesity in Saudi Arabia. Methods: An exhaustive evaluation of studies spanning different regions of Saudi Arabia, focusing on physicians' capabilities, knowledge, and practices in obesity management. This analysis also took into account the comparative approaches of countries like Canada, the UK, USA, and Hungary. Various factors, such as specialized obesity treatments, patient-centric approaches in pediatric obesity, career stages of physicians, obesity's correlation with noncommunicable diseases, and nutritional competence, were studied. Results: Nine studies were included. From a collective pool of 2430 participants across the discussed studies, challenges in obesity management were consistent. Despite having an understanding of obesity, there was a significant knowledge gap in specialized treatments, with many physicians feeling unprepared to manage the condition. Factors such as geographical diversity, physicians' experiences, external influences on pediatric obesity management, and the correlation between obesity and other health conditions were highlighted. The need for effective nutrition care, despite perceived capability, was a notable finding. Conclusion: Saudi Arabia faces a significant challenge in obesity management in primary health care settings, marked by knowledge gaps and the need for continuous training. The analyzed studies emphasize the importance of tailored interventions, robust training modules, and public health campaigns within Saudi Arabia's unique context to combat the obesity epidemic effectively.

Properties of fulvic acid (FA) extracted from the peat of the Nizhny Novgorod region of Russia by ultrasonic extraction with alkaline or ethanol solutions and further purification were studied in the paper. The purification of FA by the Lamar method was shown to possibly lead to the formation of FA polymorphs of the same composition but different structure (IR, solid-state 13С NMR, fluorescence, UV, energy-dispersive X-ray spectroscopy, SEM and optical microscopy, concentration of carboxyl and phenol groups). Aggregation of FA polymorphs in water led to the formation of nanoparticles with the average size of 8–10 nm and the zeta potential of –22 to –27 mV. The formation and properties of polymorphic supramolecular structures are greatly influenced by the drying mode. The solubility of the two FA polymorphs varied from freely soluble (3.3 mL of water per gram) after the FA solution freeze-drying to soluble (12 mL of water per gram) after the FA solution vacuum drying. The FA sample extracted by ethanol ultrasonic extraction from the peat, followed by convection drying, had a solubility of 666.7 mL of water per gram (Slightly soluble), a zeta potential of -6 mV, and a particle size of 15–20 nm.

Background: The extensor tendons are particularly vulnerable to trauma because their superficial location in a clenched fist, the thin mobile subcutaneous tissue offers little protection, and lacerations of the extensor tendons are common over joints that are easily exposed to contamination. Objective: To assess the evaluation of the postoperative early active mobilization protocol of extensor tendon repair at zone (V-VII). Methods: In this prospective study was carried out at Orthopedic Dept., 250 Bed General Hospital, Kishoreganj, Bangladesh from January to June 2023. Total 40 cases of fresh injury of extensor tendon at zone V to VII were treated. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Routine history taking with details of the injury, the object causing the injury, the dominant hand and the position during the injury, Physical examination, included the zone, and the possible tendons involved together with any associated injury. Results: Forty patients of fresh extensor tendon injuries were included in this study, their ages ranged from 20 to 55 years. There were 33 males (82.5%) and 7 females (17.5%). The dominant hand was involved in 29 of patients (72.5%). The nature of injuries was sharp cut in 34 patients (85%), with crush injuries in 6 patients (15%). The most common site of injuries was zone VI, VII and zone V respectively, and the most common tendon injured was EDC, EI, and EDM. Only 7 patients (17.5%) had single tendon injury, While 33 patients (82.5%) had multiple tendon injuries. At the end of the 6th weeks post operatively, the overall outcome result are summarized. Conclusion: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient. It will give fairly acceptable results.

All parts of Mucuna poggei and Justicia carnea have been known to possess valuable medicinal properties. This calls for the need to determine the effect of combined methanol extract of mucuna poggei and justicia carnea leaves on hematological and biochemical indices of phenylhydrazine induced anaemic albino rats. The study was done using 60 male albino rats. The rats were divided into five groups of five (5) rats each. Group 1 (non-anaemic) was administered water and feed only which served as Normal control. Group 2 was administered Phenylhydrazine only which served as negative control. Group 3 through 5 were Phenylhydrazine induced anaemia treated with combined extract (1:1) at 200 mg/kg, 400 mg/kg and 600 mg/kg respectively. The results showed a significant (p<0.05) increase in Hepatic and renal biomarkers (ALT, AST, ALP, Urea, Creatinine) of the anaemic (negative) control. The combined extract significantly restored the alteration through significant (p<0.05) dose dependent decrease in the assayed hepatic and renal function biomarkers. The hematological indices of the treated rats were maintained compared to the anaemic control. The study showed great potential of combined methanol extract of Mucuna poggei and Justicia carnea leaves capable of ameliorating anaemia.

A pharmacist in general and community pharmacist in specific is a key member of the “healthcare team” involved in achieving a common objective of better healthcare provision. The emergence of “community pharmacy” during post-world war-II era, with a known motto of “drug control” and “patient oriented practice” (POP) came in to existence. The modern pharmacy practices, are not devoid of obstacles and challenges specifically for “Newbie Community Pharmacist (NCP)”, who comes in to direct patient contact at root level, thus necessitates to strict to standards which will help not only in quality care provision but will enhance the abilities of the pharmacist to cope challenges facing at community level. Herein, we will discuss some of the concerns for NCP and their considerations to deal with.

Today, it is common practice to employ computational software tools for investigating the structure, dynamics, surface characteristics, and thermodynamics of inorganic, biological, and polymeric systems. Computational software tools are a vital part of the guide for drug discovery. It is frequently employed in approaches for rational drug design and structure-based drug design. The process of drug design and discovery is essential in the invention of a new chemical entity. For this process, plenty of computational tools are available globally, Those computational software tools are fast, free, open online excess paid. Pharmaceutical software decreases human efforts, error, and time utilization in a particular task without compromising the quality of work with great accuracy and efficiency. This software is utilized by various institutes globally related to science and medicine. A computer program that transforms an input structure according toa library of medicinal chemical transformation rules before allowing evaluation of the output structures. High throughput screening is now widely accepted as a viable option that CADD supports. The development of top-notch datasets and design libraries that may be optimized for molecular diversity or similarity has resulted from the quest for novel molecular entities. On the other hand, breakthroughs in computing infrastructure and molecular docking methods are allowing screening throughput to increase quickly.

Background: One of the most serious complications of diabetes that places an enormous strain on the patient, the healthcare system, and the world economy is diabetic retinopathy (DR). It includes long-term exposure to the metabolic changes linked to diabetes, which cause damage to the retina's microvasculature. Objectives: The aim of the study was to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in a tertiary care hospital. Methods: This cross-section observational study was carried out in the Department of Ophthalmology, North Bengal medical College. Convenience sampling technique was followed. Face to face interview was done to collect data with a semi-structured questionnaire. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). The duration of the period from July 2018 to July 2022. A total of 120 patients were participate in the study. Results: About 58.33% respondents were male and 41.67% were female. Majority (33.33%) of the respondents were within the age group of 50-59. 33.33% were service holder, 41.67% were businessman, 12.5 were day labor, 6.67% were farmer. 75% were from urban area and 25% from rural area. The prevalence of DR in this study was 41.1%. About 90% had DM of <5 years, 55% had 6-10 years, 40% had 15-20 Years, 30% had 16-20 years and only 7% had >21 years. About 50% had normal grade of diabetic retinopathy in the worse eye, 15% had Mild NPDR, 8.33% had Moderate NPDR, 6.67% had Mild to moderate NPDR with non-CSME, 2.5% Moderate NPDR with CSME, Severe NPDR with non-CSME Severe NPDR with CSME and Advanced PDR respectively. Mean FBS (mg/dl) was 160.86±70.6, Total cholesterol (mg/dl) was 183.2 ± 2.1, Triglycerides (mg/dl) was 161.2 ± 2.6, Systolic BP was 130.56±15.7 and Diastolic BP was 80.86±13.4. Patients with baseline age of <60 years were three times (AOR = 3.2:95% CI: 1.19–8.63) more likely to develop DR. The odds of DR is about 3 times (AOR = 2.91:95% CI: 1.01–8.35) higher for patients with disease duration of ≥6 years as compared to disease duration of <6 years. Systolic blood pressure also had statistically significant association with patients having blood pressure of <140 mmHg being about 3.6 times (AOR = 0.28:95% CI: 0.09–0.82) less likely to have DR as compared to hypertensive patients with systolic blood pressure of ≥140 mmHg. The other cofactors, history of hypertension, and total cholesterol level were not independent significant factors for the development of DR in our study. Conclusion: Systolic hypertension, being on insulin alone or in combination with OHA, and having diabetes for a longer period of time were all independently linked to the occurrence of DR. The significant DR prevalence our study suggests that routine patient care, including treatment facilities, has to be improved. Healthcare practitioners must make a consistent effort to educate diabetic patients about the importance of blood sugar control and hypertension management in lowering the risk of the start and progression of DR. It is advised that diabetic patients get health education regarding the importance of routine eye exams for the early detection and treatment of diabetes-related eye problems.

Background: Numerous obligatory intracellular bacteria from the Alphaproteobacteria genus Rickettsia can cause rickettsial infection. The most prevalent newly emerging and reemerging diseases are rickettsial infections. Objectives: The aim of the study was diagnosis and management of rickettsial infections among febrile patients attending in inpatient and outpatient department in a district hospital in Bangladesh. Methods: This cross-section observational study was carried out in the 250 Beded District Hospital, Joypurhat. The duration of the period from March 2022 to February 2023. A total of 250 patients participated in the study. Both male and female with any age, patients with elevated body temperature, headache, malaise, rash, nausea, and vomiting and gave consent to be included in the study. Severely ill patients, not willing to participate were excluded from the study. Weil Felix test was used in this study and a titre of 1:80 was considered to be positive. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: The mean age of the patients was 39 ± 1.9. 8% of the patients had ≤18 years of age. 16% were within the age group of 19-29 years, 28% were within the age group of 30-39 years, 24% were within the age group of 40-49 years, 14.4% were within the age group of 50-59 years and 9.6% were ≥60 years and 52% of the patients were male. 100% of the respondents had fever, 20% had generalized weakness, 15.2% had headache, 16% had cough and cold, 24% had body ache, 8% had vomiting and abdominal pain respectively, 4% had per nasal watery discharge, 36% had rash, 16% had nausea, 24% had anorexia and 4% had other symptoms. CBC & ESR and Weil Felix test were the most common (100%) investigation among the patients, Urine R/M/E in 68%, serum creatinine in 18%, USG of W/A in 15%, CRP in 18%, PBF in 7, Urine C/S in 10%, S. Electrolytes in 4% cases. We found 90 Rickettsial Infection positive patients. Doxycycline and Paracetamol and Esomeprazole were prescribed to all patients 90(100%) and followed by Linagliptin+Metformin to 20(22.22%), Glimipiride to 19(21.11%), Azithromycin to 18(20%) and Domperidon to 10(1.11%), Montelukast 9 (10%), Pantoprazole to 8(8.89%), Rupatadine to 7(7.77%), Ondansetron to 6(6.67%), Tiemonium to 5 5.57%), Fexofenadin to4(4.44%) and other treatment along with the prescribed medicines was given to 40(44.44%) patients. Authors studied the response of Doxycycline which showed 85(94.44%) cases improved within 48 hours of start of treatment. Remaining 5(5.55%) cases showed delayed response due to late presentation. Conclusion: Rickettsial illness is inextricably linked to the sociocultural life of the majority of metropolitan residents. However, a lack of medical facilities and qualified doctors makes it challenging to identify rickettsial disease in febrile patients. It's important to make an early diagnosis when treating rickettsial illness.

Background: Oral cavity bacteria can be mostly harmful if inhaled into the lungs. Hospital acquired pneumonia (HAP), a critical condition that presents clinically two or more days after hospitalization, which may increase the risk of mortality. Lacking oral care can lead to Hospital acquired pneumonia. Objective: to explore effective oral care consequence on hospital acquired pneumonia prevention. Methods: This review article is performed according to the PRISMA guidelines. The literature exploration was done in Google Scholar and PubMed databases for articles published between 2017 and 2020. The search words were “oral care, oral hygiene, intensive care, critical care, ICU, respiratory infection, lung infection, pneumonia, and adult". Results: A total of 6 studies were included, the studies were randomized controlled trials (RCTs) and observational studies. Oral care with tooth brushing and purified water twice daily can significantly reduce the incidence of HAP. Brushing patient mouth with chlorhexidine is also effective in decreasing the HAP incidence. Implementing oral care protocols in ICU with chlorhexidine solution and nurse education can significantly lower the incidence of HAP. Conclusions: Good oral and dental care, particularly with tooth brushing and purified water twice daily, can significantly reduce the incidence of HAP in intensive care unit patients.

Introduction: The incidence of Invasive Fungal Infection has increased, and it constitutes a serious threat to human health and life, especially in immunocompromised and critically ill patients. We aimed to evaluate the appropriateness of antifungal agents along with their risk factors and sensitivity pattern. Methods: It is a retrospective, cross-sectional study, which includes details of patients prescribed with systemic antifungal agents during a period of five years (01-06-2016 to 31-05-2021). Collected details were compared with Infectious Diseases Society of America (IDSA) guidelines and mycological results to determine the overall appropriateness. Results: A total of 102 patients prescribed with systemic antifungals were selected for the study. The majority of the drugs were prescribed as Definitive (59.19%) and T Fluconazole (39.4%) was the most common drug given. The most common indication for antifungal prescriptions was found to be Respiratory tract infection. Appropriateness of antifungal use was assessed on indication, dosage, contraindication, and drug-drug interaction. Overall assessment of antifungal agents and treatment strategy demonstrated that antifungal treatment was appropriate in 41.6% cases, debatable in 36% cases and inappropriate in 22.4% of cases. The most common culture specimen collected was urine and Candida tropicalis (42.86%) was the frequently separated organism from it. Sepsis (21.4%) was the most common risk factor associated with invasive fungal infection. Conclusion: By implementing an effective antifungal stewardship program, we could improve the rational use of systemic antifungals and thereby prevent the future resistance and improve clinical outcome.

Introduction: Cellulose consists of β-(1 → 4)-linked glucose units arranged in a ribbon-type conformation in a zigzag pattern. Parallel chains fit closely to each other and associate with multiple hydrogen bonds to give rise to long fibers, which are totally insoluble in water and relatively inert. Although subject to some swelling in water, cellulose is entirely unaffected by boiling in water. Objectives: The objective of this study is to investigate the potential for breaking down the pollen wall of honey-collected pollen using acid with pH of stomach acid, and to determine whether the honey-making process by bees is necessary for human consumption of the amino acid content present in pollen. Materials and Methods: Natural litchi flower honey was collected from Litchi Garden of Doctor Honey, Health & Harvest Dinajpur, Bangladesh in March 2021. 1 ml natural raw honey of litchi flower was diluted with 5 ml distilled water in a conical test tube. (Falcon). This was centrifuged in a swing-out rotor centrifuge (Labofuge, Germany) at a speed of 900 rpm for 10 minutes. The pollens made a pellet at the bottom of the tube. A sample from the pellet was taken on a glass slide and checked under the light microscope (optima) to ensure the presence of pollen. Citric acid was also added to the pollen. Results: Many of the pollen’s walls were found broken within one hour. It is visible that the contents of the pollen sacs are oozing out. One or two broken pollen was found in each 100 of the sample before adding acid whereas many were broken after adding acid. Conclusion: Honey-collected pollen's wall can be broken down using stomach acid, emphasizing the importance of the honey-making process for accessing amino acids, while preserving pollen in honey is crucial for maximizing nutritional benefits.

Introduction: Allergic rhinitis is one of the most common chronic conditions affecting all age group and it is characterized by sneezing, nasal congestion, and rhinorrhea. In some cases, conjunctivitis also occurs up on expose to a variety of irritants like pollen, duct, perfumes, and weather changes. Aim: This study evaluates the impact of COVID19 pandemic and quarantine on patients with allergic rhinitis sign and symptoms. Results: The study was conducted in the Kingdome of Saudi Arabia and 740 participants returned the online questionnaire. of those, 596 (80.5%) identified dust and weather changes as the main irritants to their symptoms, and 440 (59.5%) experienced sneezing as the main symptoms before COVID-19 pandemic. Only 89 (12%) reported symptoms relief by 90-100% during lockdowns and curfew periods. There was a significantly lower rate of medication use during the pandemic (28.32%) compared to the time before the pandemic (50.93%). During the COVID-19 pandemic, of the respondents 271 (36%) reported no improvement, 179 (23.8%) had mild improvements, 131 (17.4%) reported a moderate improvement, and 171 (22.7%) reported a significant improvement. Conclusion: The study showed that 40% of the participants had moderate to significant symptomatic relief during the periods of lockdowns and curfew of the COVID-19.