According to IDF diabetic atlas 8th edition, south –East Asian region is the 2nd highest of all IDF regions. It was estimated that. It was estimated that by 2040, this will raise to 150 million 69.1 million adults are diabetic in India according to 2015 census. Material and Methods: For every 11 persons 1 is diabetic. 1 child in every 6 births is affected by hyperglycemia in pregnancy. 2/3rd of people with diabetes is living in urban area and belongs to working age group. 1 in every 2 persons is undiagnosed. To motivate the youngsters to lead a healthy life style and create awareness about the risk of developing diabetes due to lifestyle modifications. Results: Questionnaire based study among 100 medical students further evaluation of blood glucose levels among the high risk group. We have identified that the lack of exercise was the main risk factor among the study group. There is a lack of physical activity among medical students of the study group.

Aim of the study was to find out the role of biochemical markers in diagnosis and prognosis of pancreatitis and compared this value with healthy subjects of Rajasthan. Total 200 subjects were selected in which 100 were selected as patients group and 100 were normal healthy subjects. Out of 100 patients 75 patients were male and 25 patients were female. patients were distributed age wise .Most of the male patients were alcohol abused And suffering from abdominal pain and most of the female patients suffering from gall stone and abdominal pain. Trypsin was estimated with sandwitch Elisa kit method and other biochemical parameters were performed by commercially available kit on fully auto analyzer. In male patients of age group 15-55 years Mean serum total and direct bilirubin level was 7.49±3.86 and 3.46±1.81 respectively. AST level was 268.22±71.74 and in control group mean AST level was 28.69± 5.85.P-value was found highly significant.(P≤ 0.0001) .as well as serum alkaline phosphatase level was found 779.86±456.77 and in control group mean ALP level in serum was 107.0±15.34 IU/L. mean value of amylase and lipase 486.86±154.20 and 2040±745.85 respectively. Mean serum level of trypsin was 461.16±200.72.in female patients all these parameters were also increased. We conclude that all biochemical parameters are increased in pancreatitis. Serum amylase and lipase both increases in pancreatitis but lipase is a specific test for alcohol induced or alcoholic pancreatitis. Trypsin can be used as a marker of pancreatitis.

To evaluate the effect of metformin therapy for more than three months on serum ghrelin and adiponectin level and to assess the relationship between them with insulin resistance parameters in obese patients with polycystic ovary syndrome (PCOS). A case-control study design was adopted in the Fertility and In Vitro Fertilization (IVF) Center at AL. Batool Teaching Hospital Mosul City/ Iraq, in the period between 1st of November 2013 and 1st of May 2014. This study included a group of 41 obese women with PCOS of reproductive age who used metformin for more than three months (metformin users) with another age-and body mass index (BMI)- matched group of 44 obese women with PCOS who did not use metformin (metformin non-users and served as control). A 10 ml of fasting venous blood sample was taken from each PCOS woman of the two groups. The sera were used to measure serum ghrelin, adiponectin, insulin and fasting serum glucose (FSG) level by using commercially specific kits, whereas; BMI and insulin resistance represented by Homeostasis Model Assessment (HOMA) was calculated by using especial equations. The results of this study revealed that there were no significant differences in the mean BMI, waist to hip ratio (WHR), serum ghrelin, FSG and fasting serum insulin (FSI) and HOMA-IR between the metformin users in comparison with metformin non-users obese PCOS patients groups. This study found that there was a significant higher mean serum adiponectin level of the obese metformin users in comparison with the obese metformin non-users PCOS patients. There was a significant positive correlation between BMI and insulin level, BMI and HOMA-IR and between FSG level and HOMA-IR. Also there were a very high significant positive correlation between insulin level and HOMA-IR. In conclusions, metformin therapy for more than three months in obese PCOS patients was associated with a significant higher mean serum adiponectin level than in metformin non-users group. There were non-significant changes in the mean FSG, serum ghrelin level and insulin resistance parameters. Also there were no significant correlation between neither mean serum ghrelin nor adiponectin with the insulin resistance and anthropometric parameters.

This study evaluated the tendency for Cocos nucifera juice to be effective in management of hepatic and renal anomalies in a human design. 180 male subjects were used for this study. With treatment A as the control, Cocos nucifera juice was administered in 3 doses; B, C, D-50ml, 100ml and 150ml respectively. The experimental period lasted for 42 days. The biochemical assay protocols were aimed at investigating changes relating to hepatorenal function. Biomarkers assayed for include aspartate transaminase, alanine transaminase and alkaline phosphatase for liver function biomarkers, creatinine, cystacin-3 and interleukin-18 for kidney function biomarkers. There was a dose dependent change in both liver and kidney function biomarkers. This study revealed an inverse relationship between Cocos nucifera juice ingestion and the serum level of these metabolic biomarkers. There was also a time dependent reduction as well as a progressive decrease in harmonic mean of the assayed biomarkers for all dose treatments. Cocos nucifera has the potential to be applied in the management of hepatic and renal dysfunction.

Fatigue is often cited as a contributing factor in air incidents and accidents. Usually, the words "fatigue" and "sleepiness" are used by aircrew to describe the same feelings, a questionnaire has been developed for subjective level assessment of fatigue and sleepiness among Moroccan aircrew. A 4-month prospective study including all aircrew (civilian, military) and air traffic controllers was conducted at the Aero-medical center of Rabat during their review visit. The questionnaire included the Pichot scale for fatigue and Epworth scale for sleepiness. It was filled anonymously. Out of more than 400 cards distributed, only 200 were exploitable. 23% of the subjects in the study had moderate fatigue. 6.5% of the sample presented moderate sleepiness and 4.5% had excessive daytime sleepiness. These two states seem to be preponderant in young aircrew population especially cabin crews. The occurrence of fatigue and daytime sleepiness in aircrew especially at the beginning of their career can be explained by the difficulty of adapting to aeronautical constraints. It is important to remember the countermeasures of fatigue to preserve aviation safety

Blood transfusion is a routine, life-saving medical intervention which is generally regarded as safe when done appropriately, but it is not absolutely free from adverse reaction. The aim of the study was to analyze the Adverse Transfusion Reaction (ATRs) as a part of Haemovigilance Programme of India at VIMSAR, Burla. This study was prospective and observational. All blood transfusions and adverse reaction which occurred due to transfusion at V S S Institute of Medical Science and Research (VIMSAR), Burla, between June 2018 and November 2018 were studied. The reactions were reported in a pre-designed transfusion reaction (TR) reporting form for blood and blood products as per the Haemovigilance software, PvPI. ATRs were also analyzed with respect to types of blood products. Total blood components issued by our blood bank to various departments and total ATRs during the study period were 13145 and 121 respectively. Majority of the reactions occurred with whole blood (0.71%), followed by packed red cells (0.17%). The most common ATR observed was allergy (80.16%) followed by febrile Non hemolytic TR (19.83%). Most of the ATRs were acute reactions. The study emphasizes the different reaction accompanied with blood transfusion, and how it can be minimised by proper laboratory technique so that quality and safety of transfusion therapy can be improvised.

The species Jatropha curcas of the family Euphorbiaceae, widespread in Central Africa, is a shrub 5 to 8 m high; widely used in traditional medicine. The interest of the present study is the evaluation of the hypoglycemic and antihyperglycemic activity of the aqueous extract of its roots and the formulation of capsules from the dry extract. After the harvest of Jatropha curcas in the region of the center Cameroon, roots underwent clearly a decoction in distilled water, maceration in ethanol 80 % and in pure methanol. Characterization of secondary metabolites families was performed by coloring and phytochemical precipitation tests. Subsequently, some of these metabolites were measured from standards. The animal material (male and female rats) was prepared for demonstration of hypoglycemic and antihyperglycaemic activity using as method the measurement of blood glucose every 30 minutes for 3 hours. The determination of the yields of the extracts showed a significant profitability, 8,14% for the aqueous extract. Phytochemical screening analysis and determination of phenolic compounds revealed that the aqueous extract had high levels of total phenols (24.037 mg Eq AG / g dried material), total flavonoids (9.493 mg Eq Q / g DM), flavanols (2,704 mg Eq R / g DM), flavones and flavonols (2,053 mg Eq Q / g DM), saponins (6,270%), tannins condensates (0,019 mg Eq C / g DM) and anthocyanins (2,625 mg / ml), relative to the methanolic extract and the ethanolic extract. In addition, the methanolic extract was found to be the most titrated in alkaloids (0.698%). Administration of the aqueous extract of root at a dosage of 500 mg/kg of body weight significantly decreased glycaemia (p < 0.05) compared to the group of rats which received distilled water at 10 ml/kg and showed a significant change in percentage of glucose reduction (p = 0.003), comparable to that of glibenclamide 10 mg / kg of body weight, the sulfonylurea hypoglycemic drug of reference. Our results show that the roots of J. curcas have an interesting hypoglycemic effect suggesting their use as extracts in hypoglycemic treatments.

A study on the level of fibrinogen in Type 2 Diabetes patients and its influence on Peripheral Arterial Disease. Three groups (Group A- Diabetes patients, Group B- patients with DM+PAD, control group of healthy volunteers) of patients were included. Plasma fibrinogen level of all the patients were measured and is correlated with age, sex, BMI, WHR, HbA1C, FBS and ABI of the patients. PAD patients were identified with the help of ABI measurement. PAD is an expression of systematic atherosclerotic disease, if it is not diagnosed in the early stage it will lead to serious complications like Myocardial infarction, stroke and death. Role of haemostatic factors particularly Fibrinogen in vascular disorders has gained considerable interest. Comparatively increased fibrinogen concentration was seen in patients with both DM and PAD (414.97±28.73). We have also found that fibrinogen is increased in some diabetic patients with poor glycaemic control. This elevated fibrinogen can be considered as an indicator for cardiovascular disorders in diabetic patients. These results underline the possible relation between fibrinogen and presence of PAD in diabetic patients and thus the study reflects the importance of proper maintenance of glycaemic status in Diabetic patients.

Complicated UTIs (cUTIs) are one of the leading causes of the gram negative bacteraemia which occur in patients who have a functionally, metabolically, or anatomically abnormal urinary tract. The primary objective of this study was to compare efficacy of Piperacillin/Tazobactam (PT) and Cefoperazone/Sulbactam (CPS) combinations in complicated Urinary Tract Infections. At entry, total 92 patients admitted in the hospital due to cUTI were enrolled. Among of 92 patients, 49 patients were given PT while 43 patients were given CPS combinations. Clinical symptoms were registered and scored as mild (1) moderate (2) or severe (3). The follow-up were done daily till the patient is discharged. Thereafter, one follow up visit was done within 4 to 9 days of after discharge, termed as test of cure (TOC). Furthermore, one late follow up visit after 6 to 8 weeks was done, known as late follow up visit (LFU). Clinical assessments and microbiological analysis were done at the time of TOC and LFU. The mean baseline clinical score for PT and CPS were 10.89 ± 2.23 and 10.28 ± 2.33, respectively. At TOC visit, PT and CPS groups, clinical scores were 0.86 + 2.35 and 1.36 ± 3.48, respectively; suggesting significant improvement from baseline (p< 0.001). Rate of clinical improvement at TOC visit was 92.68% and 87.50%, while microbiological cure rate was 87.80% and 93.75% with PT and CPS groups respectively. While, at LFU visit, clinical scores in PT and CPS groups were 1.32 + 3.37 and 1.65 + 3.56, respectively, suggesting significant improvement from baseline (p < 0.001). Clinical cure rate at LFU visit was 87.80% and 87.75% while microbiological cure rate at LFU visit was 82.92 and 77.00% in PT and CPS groups, respectively. These results suggest that both regimens have no significant difference for the treatment of cUTI. PT and CPS, both the combinations, are equally efficacious in treatment of cUTI.

Plants have formed the basis of sophisticated traditional medicinal systems that have been in existence for thousands of years and continue to provide mankind with new remedies. The study of total ethanol extract of Shorea robusta oleoresin and Wrightia tinctoria bark investigated the antiallergic activity study by sheep (Capra hircus) serum and compound 48/80 induced mast cell degranulation method using ketotifen fumarate and antipruritic activity study by compound 48/80 method using chlorpheniramine maleate as standard. The results showed both plants are excellent candidates.

The repair of eyelid needs a good knowledge of reconstruction techniques. The goal of this work is to study epidemiological and technical aspects of eyelid defects in our context, and to evaluate their functional and aesthetic repair. We report cases concerned by loss of eyelid tissue operated between September 2011 and September 2016. Epidemiological, clinical and histo-pathological aspects are described, the repair processes and various surgical techniques are discussed. Among the identified cases of eyelid defects, 74% were malignant tumoral pathology, while 26% were benign. The repair techniques used were suture, direct healing, skin graft, flap of Mustardé with mucous chondro graft, frontal flap and sub-mental flap. The eyelid defects need functional and aesthetic valid repair, the various reconstruction means should begin from the simple ones to more complex.

Aim of this work was to compare properties of two etching gels produce by Kerr Orange and Spofa Dental. Etching gel are water solution of phosphoric acid using in total etch techniques. They are applicable on enamel surface for 30 seconds to make partially dissolving of hydroxyapatite crystals and increase mechanical adhesion between bonding agents and tooth structure. Materials and methods two commercial phosphoric acid gels (Kerr and Spofa Dental) were tested in consistency, thixotropic properties, water disintegration, force necessary for extrusion material from syringe, fil thickness. Results: Kerr materials has higher consistency, is less thixotropic compare to Spofa product, has longer time to dissolve (18 min), lower force necessary to extrusion 5 N and film thickness 4 microns. Conclusion: On the market exist etching gel based on different gelling agent organic gums or fumed silicas. Some clinician prefer material with higher viscosity for some application, other groups of practicing doctors are using less viscous materials.

The malignant hyperthermia is a rare autosomal dominant disease of the skeletal muscles. Triggered by volatile anesthetics and succinylcholine which leads to excess release of calcium from sarcoplasmic reticulum that leads to hypermetabolic status of the body and it could be fatal. The incidence between 1:10000 and 1:250000 anesthetics. It is more common in males than females, and the young more than old people. MH cause by mutation in RYR1, CACHA1S or STAC3 genes. Symptoms of MH are muscle rigidity, tachycardia, hypercapnia, hypoxemia and hyperthermia. The symptoms of MH could be mistaken by other conditions and therefore delay the treatment. Treatment is by stopping the triggering agent, symptomatic treatment to prevent complications and the only pharmacological agent that reverses the MH is Dantrolen. IVCT is the gold standard to diagnose MH but it is invasive. Genetic testing is less invasive and also help in diagnosis of MH and identification of the affected gene, but it does not replace IVCT.

Nasal obstruction (NO) is defined as a single or bilateral nasal breathing disorder, recent or old, permanent or intermittent. It is a frequent problem in pediatrics and underestimated because of the absence of complaint in young children or unknown when the complaint is unilateral [1]. Although the majority of causes of ON belong to the infectious pathology, one must know to think of a syndrome malformative or tumoral [2]. The ON can cause significant troubles both locally and generally [1]. It is necessary to objectify the cause quickly especially in the newborn because of the vital consequences that this obstruction can cause [1].

The choroidal macular neovascularisation (NVC) of the young subject is a serious condition that threatens visual function. The decrease in marked visual acuity is related to the foveolar or juxta-foveolar localization of the neovessels. The therapeutic management of idiopathic NVC of the young subject is difficult due to frequent recurrences despite the treatment. The use of anti-VEGF (vascular endothelial growth factor) represented a turning point in the management of this condition. The intravitreal (IVT) injection of bevacizumab appears to be effective and well tolerated.

Skeletal muscle metastases are an exceptional mode of revelation of broncho-pulmonary cancers, we report a case of a patient with lung cancer disclosed by skeletal muscle metastasis. The patient consulted for a painful mass of the left calf with significant weight loss, the medical imagery shows an intramuscular process and the ultrasonography guided biopsy shows an infiltration of the muscle with metastatic adenocarcinoma, immunohistochemical patterns suggested the pulmonary origin, the treatment included muscle resection and chemotherapy. Skeletal muscles metastases from lung cancer are rare and although indicative of a poor prognosis, the treatment is poorly codified and differs from case to case.

PLMA is a recent, complex, and ingenious development with some added features of Classic LMA like Modified dual cuff ,Drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of Proseal laryngeal mask airway and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure. 100 patients, ASA risk I & II, posted for elective laparoscopic were recruited in the study. All the patients between 18 to 45 yrs of age were randomly divided in two groups Group PLMA and Group ETT (50 patients each). Attempt of insertion of airway device, Leak pressure, pulmonary ventilation, Hemodynamic; heart & MAP, gastric distention were recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in both the groups. Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia .Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before & after peumoperitoneum were comparable in two groups. After head low position peak airway pressure is slightly raised in Group PLMA. Gastric distension was noted higher in Group PLMA (8%).Incidence of sore throat (22%), nausea vomiting (14) airway trauma (14%) was higher in group ETT. Hemodynamic stability was better in PLMA group at time of induction and comparable in two groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post operative sore throat, nausea vomiting was higher with endotracheal tube.

The aim of the study was to study effectiveness of inhalation sevoflurane with the laryngeal mask airway (LMA) in children undergoing surgeries below umbilicus. Thirty premedicated children 3-12 years old with the American Society of Anaesthesiologists physical status of I to II were enrolled and received induction with sevoflurane 7% by face mask and maintained with 50% oxygen and 50% nitrous oxide mixture followed by 1.7% sevoflurane with LMA. Demographic data, induction time, number of attempts, LMA insertion, removal and recovery times, haemodynamic parameters, complications, Aldrete score and child’s behaviour score were recorded. LMA insertion was successful at the first attempt in 93% with sevoflurane. LMA insertion, removal and recovery times were (1.26±0.36, 2.76±0.51, 5.16±1.6 minutes respectively). Perioperative minor complications were there. Recovery milestones including Aldrete score in the group was (9.03) t 5 minutes and comparable at 15 and 30 minutes. There was a greater incidence of excitatory phenomena with sevoflurane. Haemodynamics were studied. Sevoflurane provided short LMA insertion, removal and recovery times in children undergoing minor surgeries below umbilicus with little perioperative complications. Agitation was seen with sevoflurane.

Mental health disorder is one of the major health problems, which requires early & effective treatment. WHO global burden of disease 2001 estimates four main psychiatric causes leading to disability, which is Depression, Alcohol abuse, Schizophrenia & Bipolar disorder. Although current psychotropic medicines have remarkable effect on mental illnesses, their utilization in clinical practice needs to be done regularly hence, current study aims to observe the utilization and prescribing pattern of various drugs used in department of psychiatry, according to various WHO drug use indicators. It is a prescription based prospective, observational study conducted on 1200 prescriptions of patients attending department of psychiatry for 18 months. Total of 3632 drugs were prescribed in 1200 prescriptions analyzed, where 48.4% (581) were males and 51.6% (619) were females, majority of the patients 56.25% (675) belonged to age group of 21-40yr, 85.67% (1028) individuals were married. Out of total drugs prescribed 2971 (81.80%) were psychotropic drugs. Average no. of total drugs & psychotropic drugs prescribed per encounter was 3.03 & 2.48 respectively. 1680 (46.26%) drugs were prescribed from the WHO EDL formulary (2016), all the drugs were prescribed by brand names, percentage of prescriptions with injectable drugs accounted for 4.75%. Polytherapy (>5drugs) was observed only in few prescriptions 26 (2.17%). This study advocated an overall rational utilization of psychotropic drugs with fewer deviations due to the prescription practices of healthcare providers, which needs an improvement, to ensure rational use of drugs.

Objectives: To summarize and critically evaluate the body of research on the connection between obesity and sudden cardiac death (SCD) risk. Methods: To locate research that met the inclusion criteria, a thorough computerized search of relevant databases was carried out. A comprehensive search was carried out on PubMed, SCOPUS, Science Direct, Cochrane Library, and Web of Science to locate relevant material. Results: Our data included seven trials with 104,697 participants and 68,738 (65.7%) were males. The prevalence of SCD among obese patients ranged from 0.05% to 37.1%, with a total prevalence of 1111 (1.1%). Five studies stated that as BMI rises, so does the chance of SCD. Obesity in the early stages of life and obesity and overweight throughout adulthood are risk factors for SCD [13, 15]. Many studies highlighted the interplay between obesity and cardiovascular comorbidities, such as hypertension, coronary artery disease, and heart failure, in increasing the risk of sudden death. Conclusion: The results of this comprehensive review offer strong evidence that obesity poses a substantial risk of sudden death, with the risk rising as obesity severity increases. In those who have pre-existing cardiovascular problems and significant obesity, the relationship is very high. Subsequent investigations have to concentrate on improving comprehension of the correlation between obesity and unexpected mortality, as well as creating practical methods to lower this risk in medical settings.

Background: Para-prosthetic leakage (PPL) is a significant complication following mechanical prosthetic mitral valve replacement, potentially impacting patient outcomes. The choice of suturing technique, continuous or interrupted, plays a pivotal role in determining the frequency and severity of PPL. Objective: To compare the frequency of para-prosthetic leakage in patients undergoing mechanical prosthetic mitral valve replacement using continuous versus interrupted suturing techniques. Methods: This observational study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2015 to August 2017. A total of 40 patients requiring mitral valve replacement were included and randomly divided into two groups: Group A (continuous suturing, n=20) and Group B (interrupted suturing, n=20). Baseline demographic and clinical data were recorded. The primary outcome was the incidence of PPL, assessed by transthoracic echocardiography at one month postoperatively. Results: The mean age of the patients was 37.3±11.5 years in Group A and 40.2±11.1 years in Group B. Mild PPL was observed in 15% of patients in Group A and 10% in Group B, a difference that was statistically nonsignificant (p>0.05). PPL jets in both groups were predominantly mild and clinically insignificant. The continuous suturing technique was associated with significantly shorter cross-clamp (57.8±22.4 vs. 77.5±18.6 minutes; p<0.05) and bypass times (105.9±37.3 vs. 134.7±33.2 minutes; p<0.05) compared to the interrupted technique. Conclusion: Both suturing techniques demonstrated comparable rates of para-prosthetic leakage, with a slight, nonsignificant trend toward reduced PPL in the interrupted group. However, the continuous suturing technique provided the advantage of reduced operative times. Further large-scale studies are recommended to validate these findings.

Background and Aims: Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity, mortality, poor functional capacity, poor quality of life and associated high costs. Anemia is a frequently encountered comorbid illness in heart failure. It develops due to the complex interaction of other associated comorbidities like chronic kidney diseases (CKDs), diabetes mellitus, hypertension, micronutrient deficiency and blood loss disorders. Hence, this study was aimed to find out the prevalence of anemia and associated factors among patients with heart failure at tertial care hospital, Dhaka, Bangladesh. Methods: A hospital based cross sectional study was conducted Department of Cardiology July 2017 August 2018 among consecutively selected 200 patients at BSM Medical University Hospital. Socio-demography, clinical features and laboratory parameters to evaluate anemia were obtained. Ethical clearance was taken from the Institutional Review Committee of institute. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated and chi square test at 0.05% level of significance was used to find the association. Results: The prevalence of anemia was 65%. Out of 200 patients, majority had iron deficiency anemia (40%), followed by anemia of chronic disease (10%). In this study population, majority (98%) of patients were above age more than 40 years of age and the mean age of the study participants was 65.4±12.5 yrs. More 104 (52%) were male. Among the various religion 87% were Muslim, Hindu (12%) and 1 % other ethnicity. Majority of the study population (61%) were illiterate. 60 percent had iron deficiency without anemia. Female patients 144 (72%) and patients with chronic obstructive pulmonary disease (COPD) 60 (30%) had significantly higher prevalence of anemia (p value <0.05). Conclusions: Nearly two third of heart failure patients had anemia among which iron deficiency anemia was the commonest. Female and patients with COPD had higher prevalence of anemia.