N-nitrosamines are carcinogenic impurities most commonly found in groundwater, treated water, foods, beverages and consumer products. The recent discovery of N-nitrosamines in pharmaceutical products and subsequent recalls pose a significant health risk to patients. Initial investigation by the regulatory agency identified Active Pharmaceutical Ingredients (API) as a source of contamination. However, N-nitrosamine formation during API synthesis is a consequence of numerous factors like chemistry selection for synthesis, contaminated solvents and water. Furthermore, apart from API, N-nitrosamines have also been found to embed in the final product due to degradation during formulation processing or storage through contaminated excipients and printing inks. The landscape of N-nitrosamine contamination of pharmaceutical products is very complex and needs a comprehensive compilation of sources responsible for N-nitrosamine contamination of pharmaceutical products. Therefore, this review aims to extensively compile all the reported and plausible sources of nitrosamine impurities in pharmaceutical products. The topics like risk assessment and quantitative strategies to estimate nitrosamines in pharmaceutical products are out of the scope of this review.

Work-related musculoskeletal disorders (WMSDs) are common health issues affecting workers across various industries. These disorders include conditions like back pain, neck strain, shoulder problems, and repetitive strain injuries, often caused by prolonged poor posture, repetitive movements, or heavy physical work. The prevalence of WMSDs varies globally but is generally high, especially among occupations involving manual labor, desk work, or tasks requiring repetitive motions. Studies indicate that a significant percentage of workers experience discomfort or injury at some point in their careers, leading to substantial personal and economic consequences. The impact of WMSDs on quality of life can be profound. Workers suffering from these conditions often experience chronic pain, reduced mobility, and decreased productivity. These physical limitations can lead to emotional distress, loss of job satisfaction, and social isolation. Moreover, the ongoing health issues can increase healthcare costs and result in work absenteeism or disability. Addressing the prevalence and impact of WMSDs is crucial to improving workers' well-being, enhancing productivity, and reducing associated healthcare burdens

The preformulation study begins with the introduction of a novel chemical. It involves the analysis of physical, chemical, analytical, and medicinal properties related to molecules and provides guidance on suitable alterations to improve molecular efficacy. The examination of preformulation parameters pertains to the creation of effective, safe, stable, and reliable pharmaceutical formulations. Terbutaline is a selective β2 adrenergic receptor agonist often utilised in the acute and long-term management of bronchial asthma, chronic bronchitis, emphysema, and other chronic obstructive pulmonary disorders characterised by reversible bronchial hyperreactivity. Terbutaline sulphate is a short-acting bronchodilator that can be administered orally, parenterally, or by inhalation. The principal objective of the preformulation research of terbutaline is to generate knowledge that facilitates the creation of stable and bioavailable dosage forms.

Out of all the several types of gastro-retentive drug delivery systems, floating drug delivery is thought to be the most efficient and effective system. Enhancing the bioavailability of medications with a stomach absorption window is mostly dependent on two key parameters: short gastric residence times (GRT) and variable gastric emptying times (GET). The floating drug delivery method is a low-density system that can be either non-effervescent or effervescent, but it must have enough buoyancy to pass over the contents of the stomach and stay buoyant there for an extended period of time without slowing down the stomach's rate of emptying. Drugs that are unstable in the lower intestine environment, have a limited absorption window in the upper gastrointestinal tract, are lowly soluble at higher pH levels, and are active locally can be delivered via the floating drug delivery system approach. The physiological and formulation factors influencing stomach retention time are included in the latest advancements in floating drugs delivery systems. Bringing together the most recent research on classification, factors influencing the stomach residence time of floating drug delivery system, and the benefits and drawbacks of application mechanisms of action is the fundamental objective of crafting this review study.

This review article discusses the critical role of social services in helping families care effectively for long-stay patients following discharge from hospital. Conscious that there are complexities that surround long stay patients, the article evaluates how integrated social service interventions promote coordinated care, improve patient discharge planning, and close the gap between hospital and home environment. Such important factors as communication, cultural competence and allocation of resources are discussed to point out their influence on the families’ willingness to support patients after discharge. The research shows that high social support systems enhance health outcomes, decreases readmission rate, and makes the transition to community care easier. However, such persistent barriers; including lack of funding, lack of staff, and systemic fragmentation impede the effectiveness of social services. Through the identification of these barriers, the review highlights the need for improved collaboration between healthcare providers, social workers and community organisations. It requires further studies to shed more light on the dynamics of social services and their effects on patients and families experience, which in the end would call for policies that favor creation of equitable access and comprehensive support mechanisms for long-stay patients and caregivers.

Objectives: To systematically review and synthesize available clinical and experimental evidence on the effects of beta-blockers in the treatment of acne vulgaris. Methods: A thorough search across four databases identified 412 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 209 publications, of which 29 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. Results: We included 5 studies with a total of 205 patients and 140 (68.3%) were females. The findings consistently indicated beneficial effects in the management of non-inflammatory acne lesions, post-acne erythema, and acne scarring—particularly when used in conjunction with fractional CO₂ laser therapy. Across all studies, the treatment was well tolerated with no significant adverse effects reported. Conclusion: Topical beta-blockers, especially timolol maleate 0.5%, represent a promising adjunct in the treatment of acne vulgaris. Their clinical effectiveness, safety, and affordability make them a compelling option, particularly for patients unresponsive to or intolerant of standard therapies. Further randomized trials are necessary to validate their role and establish standardized treatment protocols.

Objectives: To assess the predictive value of Pediatric Early Warning Scores (PEWS) for identifying respiratory deterioration in children presenting to the emergency department. Methods: A thorough search across four databases identified 455 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, 36 full-text articles were reviewed, with 5 studies ultimately meeting the criteria for inclusion. Results: We included five studies with a total of 155,836 children and 87,424 (56.1%) were males. PEWS has been demonstrated to significantly enhance clinical outcomes by enabling early recognition of patient deterioration, allowing for preemptive action. It has shown potential as a predictive tool for hospitalization, particularly in identifying children at risk of severe outcomes. PEWS also aids clinicians in prioritizing patient care, escalating care more effectively, and making informed decisions regarding the need for intensive monitoring or transfer to specialized care units. Conclusion: PEWS is a valuable tool in pediatric emergency and critical care, with significant potential to improve patient outcomes by facilitating the early detection of deterioration. However, to maximize its benefits, PEWS should be integrated into a broader clinical assessment and decision-making framework, complemented by other diagnostic indicators and clinical judgments. Future research should focus on refining the scoring system to enhance its sensitivity and specificity, tailoring its application to effectively address different pediatric conditions.

Background: Chronic dacryocystitis is a common condition caused by an obstruction in the nasolacrimal duct, leading to excessive tearing, recurrent infections, and discomfort. The condition is often managed through dacryocystorhinostomy (DCR), which can be performed via two primary techniques: external DCR and endoscopic endonasal DCR. The external approach, a well-established procedure, requires an incision over the lacrimal sac, while the endoscopic technique offers a minimally invasive alternative with no external incision. The effectiveness, complication rates, and recovery times of these two methods are subjects of ongoing debate. Objective: This study aims to compare the outcomes of external versus endoscopic endonasal DCR in the management of chronic dacryocystitis. Methodology: An observational study was conducted at the Department of Ophthalmology, a tertiary hospital in Dhaka, from January 2024 to January 2025. A total of 30 patients diagnosed with chronic dacryocystitis were divided into two groups, with 15 undergoing endoscopic DCR and 15 undergoing external DCR. Demographic data, preoperative complications, and postoperative outcomes were recorded and analyzed using statistical methods to assess the efficacy of both approaches. Results: No significant differences were found between the two groups in terms of age, gender distribution, or preoperative complications. However, the mean duration of surgery was significantly longer in the endoscopic group (60.5 ± 7.9 minutes) compared to the external group (53.1 ± 6.2 minutes) (p = 0.042). Postoperative results revealed that 76.7% of the endoscopic group and 83.3% of the external group had patent drainage systems, with no statistically significant difference in epiphora rates or sac patency between the groups. Bleeding complications were mild to moderate, and no significant differences in severity were observed between the two techniques. Conclusion: Both external and endoscopic endonasal DCR are effective for treating chronic dacryocystitis, with comparable outcomes in terms of epiphora resolution, sac patency, and complications. While the endoscopic technique showed a longer surgical duration, the two approaches yielded similar results in postoperative follow-ups. The choice of technique should be guided by individual patient factors, surgeon expertise, and patient preferences, as both methods offer satisfactory results in chronic dacryocystitis management.

Background: Arsenical keratosis, a chronic skin disorder resulting from prolonged exposure to inorganic arsenic, poses a significant public health challenge in arsenic-endemic regions like Bangladesh. Characterized by hyperkeratotic lesions, particularly on the palms and soles, the condition is a known precursor to skin cancer. Current treatment options offer limited efficacy, necessitating the exploration of alternative therapies. Objective: This study aimed to investigate the dose-dependent cytotoxicity of Nigella sativa seed extract and assess its therapeutic potential in the management of palmar arsenical keratosis. Methods: Conducted over 17 months, this observational study involved 32 patients diagnosed with moderate to severe palmar arsenical keratosis from two high-risk unions in Chuadanga, Bangladesh. Nigella sativa seed extract ointment was formulated and applied topically. The primary outcome was the reduction in the size of keratotic nodules, measured before and after 12 weeks of treatment using vernier slide calipers. Arsenic levels in patients’ water and nail samples were analyzed using a modified silver diethyldithiocarbamate method. Statistical analyses were performed using paired t-tests and Pearson correlation. Results: Topical application of Nigella sativa seed extract resulted in a statistically significant 72.8% reduction in mean lesion size (from 55.4 ± 29.8 mm² to 15.1 ± 10.8 mm²; p < 0.0001). No significant correlation was found between lesion size reduction and duration of arsenic exposure (r = -0.28), duration of lesion appearance (r = -0.17), or arsenic concentration in drinking water (r = -0.19). Patient adherence to treatment was high (mean adherence: 94.0 ± 6.6%), and only one case of mild, transient local irritation was reported. Conclusion: The findings demonstrate that Nigella sativa seed extract exhibits dose-dependent cytotoxicity against hyperproliferative keratinocytes, making it a promising, well-tolerated topical therapeutic for palmar arsenical keratosis. Compared to previous treatments, this natural formulation offers superior efficacy and minimal side effects, warranting further investigation through larger clinical trials.

Background: Ischaemia or infarction occurring due to Coronary Artery Disease (CAD) causes left ventricular systolic and Diastolic dysfunction (DD). DM speeds up the process of coronary atherosclerosis as well as functional and structural cardiac impairments, exhibiting DD at the early stages. Severity of CAD is best assessed by coronary Angiography (CAG). Early diagnosis of this condition is warranted as the mortality risk from it is high. The objective of this study was to detect the CAD in diabetic chronic stable angina with grade IV DD. Material and Methods: 74 Diabetic patients with chronic stable angina with grade-IV diastolic dysfunction were included in this cross-sectional observation study which was done in department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2023 to June 2024. Results: 32 (43.24%) subjects in rural and 42 (56.75%) subjects in urban areas. Proportion of males was 55%. Mean age of study population was (43 + 4.50) years. Mean age(57+7.0 vs 40+8.21years) in rural was significantly higher than urban subjects. 69 (51.06%) were SOB, 26 (19.24%) were tachycardic, 14 (10.36%) had bradycardia, 59 (43.66%) had hypotension, 21(15.54%) had raised JVP, 19(14.06%) had basal crepitation, 19(14.06%) had dependent oedema, 7(5.18%) had hepatomegaly and only 6(4.44%) had Ascites. Most of the dyspneic patients were in NYHA III stage. Around 30% patients were right dominant coronary artery. Most patients had significant stenosis in both LAD and LCX. About one third patients had insignificant stenosis in RCA. Conclusion: There is a relationship between coronary artery disease and Grade IV DD.

The purpose of this study was to assess the demographic, clinical, and haematological characteristics of women with hypertensive disorders of pregnancy (HDP) compared to normotensive pregnant individuals during their third trimester. It was a cross-sectional study involving 270 women with HDP and 270 normotensive individuals admitted to the maternity unit at Nelson Mandela Academic Hospital in South Africa. The definition of HDP followed the International Society for the Study of Hypertension in Pregnancy guidelines. Blood pressure was measured using an automated device and blood samples were collected for measurement of haemoglobin, platelet count, creatinine, alanine transaminase (ALT), aspartate transaminase (AST), and lactate dehydrogenase (LDH). The median age was 27 years while the youngest and oldest were 15 years and 46 years respectively. The unemployment rate was higher among women with HDP compared to normotensive individuals (p = 0.017). HIV prevalence showed no significant difference (p > 0.05). Hypertensive cases had higher median pulse rates [87(74-98) vs 82 (IQR:67-95) b/m, p = 0.023] and lower median platelet counts [(230 (IQR:159-281) vs 240 (IQR:192-293) x109/L, p = 0.009). Additionally, hypertensive cases had significantly (p < 0.0001) higher median levels of urea (3 vs 2 mmol/L), creatinine (60 vs 50 umol/L), AST (28 vs 21 u/L), ALT (14 vs 11 u/L), and LDH (383 vs 270 u/L).In conclusion, women with HDP exhibit distinct clinical and haematological differences compared to normotensive controls, highlighting the importance of careful monitoring for patients with HDP to mitigate potential complications.

This study presents the development and validation of a stability-indicating UPLC method for the simultaneous estimation of Sulfamethoxazole and Clindamycin in both bulk and formulated forms. The method was validated following ICH Q2(R1) guidelines, assessing parameters such as accuracy, precision, and ruggedness. Forced degradation studies were conducted under various stress conditions, including acidic, basic, oxidative, wet heat, and UV exposure, to evaluate the stability of the drugs. The method demonstrated high accuracy with recovery rates between 99.62% and 100%, and precision with %RSD values below 0.23%. Significant degradation was observed under acidic and basic conditions, while the drugs remained stable under oxidative and wet heat conditions. The developed method effectively distinguishes the active pharmaceutical ingredients from their degradation products, confirming its suitability for routine quality control and stability testing.