End-stage kidney disease (ESKD) is a serious condition that has a significant impact on patients' lives. The most preferred treatment is to get a kidney transplant, or the patient is shifted to dialysis options including haemodialysis (HD) and peritoneal dialysis (PD). Peritoneal dialysis is one of the effective modalities for the treatment of end-stage kidney disease (ESKD), but it was found to be associated with a serious complication called peritoneal dialysis- associated peritonitis (PDAP). The consequences of PDAP have been found to include removal of the catheter, relapse, transfer to haemodialysis, and death. Thus, it is usually treated using the appropriate antibiotic, which is based on the results of the culture. However, most of the conventional antibiotics used for the treatment of PDAP are not currently showing effectiveness, which is due to the growing resistance worldwide among the causative micro-organisms including Gram-positive and Gram-negative bacteria. Therefore, newer antibiotics that can eradicate these high-resistance microorganisms are required. This article reviews the available examples of novel antibiotics that can be used for peritonitis caused by strains that are showing resistance against conventional antibiotics. Examples include antibiotics like oxazolidinone, lipoglycopeptide, glycylcycline, moxifloxacin and cephalosporins.

Background: Urinary retention is a worldwide health problem mostly noted in elderly men who may have benign prostatic hyperplasia (BPH), cancer of the prostate (Cap), urethral stricture disease or bladder tumour. It has a negative impact on the quality of life (QOL) of the sufferer as well as national or global economy. Urethral catheterization is used to relief the retention and suprapubic cystostomy where the urethral route fails or it’s contraindicated. Complications have been reported especially when catheters are worn for prolonged periods of time. The aim of this work was to study the burden of prolonged use of catheters after urinary retention. Patients and Method: The study was conducted in March 2021 and lasted for four (4) weeks to prevent data duplication since our patients change their catheters once in 4 weeks. A questionnaire was designed and completed by all patients after informed consent was obtained. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 and results used for discussion. Results: Eighty two (82) patients with a mean age of 63.12±14.67 years were studied. Aetiology of urinary retention was BPH, Cap, and Urethral stricture in 58.5%, 19.5% and 23.0% respectively. More patients were in their 7th and 8th decades of life. Most patients had indwelling urethral catheter (65.9%), average duration of catheter use was 21.26 months. There was no statistical significant difference in the mean duration between those who used SPC and Urethral catheter (P= .411).Ninety-eight (98.7%) of patients had complications and 22% of them reported more than five (5) complications. Qol correlated poorly with those who had sexual issues due to prolonged catheter use. The estimated annual cost for catheter change was between N1.5million and N2.0 million in our facility. Conclusion: Prolonged catheter use is a source of concern to patients and poses serious health-related and financial burden to them.

Background: Measurement of Prostate Volume (PV) is fundamental in the proper management of patients with benign prostatic hyperplasia (BPH). Although a crude way of assessing PV, digital rectal examination (DRE) has been used in various centres and then objectified by the use of Transrectal Ultrasound Scan (TRUS) measurement for reasons of accuracy. Prostate volume measurement together with the use of international prostate symptom score (IPSS) is central in choosing treatment modalities whether medical or surgical. In this study, we aimed at correlating PV measured by DRE and TRUS. Patients and Methods: This is a prospective study of seventy four (74) patients being managed for BPH in our facility between September 2019 and December 2020 who met inclusion criteria. Full clinical history was obtained together with physical examination and well-focused DRE of the prostate to estimate PV based on Romero et al., technique combined with the sliding scale technique. Subsequently patients were sent for TRUS measurements of the prostate which is also a routine procedure in BPH managements. Data were collated and analysed using statistical package for social sciences (SPSS) version 20.0 Results: A total of 74 patients were studied with a mean age of 63.05±9.89 years ranging from 43 to 90 years. Mean PV estimated by DRE was 47.91±14.16 mls and that by TRUS was 53.42±25.33 mls. There was a statistically significant correlation in PV measurements between the two modalities (P v=.750, PV < .05). Conclusion: PV measured by DRE closely approximates TRUS measurements.

Joint effusion is a common clinical problem throughout the world. Synovial fluid analysis is one of the most important diagnostic tests to differentiate various inflammatory and non-inflammatory joint diseases. Gross examination and cell count of synovial fluid are two important test modalities. A comparison of performances of the tests would enable us to emphasize on the diagnostic procedures for better outcomes. A total of 105 cases were included in this study, performances of the tests such as accuracy, sensitivity, specificity, positive and negative predictive values of each test modality were calculated for comparison. Joint effusions were diagnosed as 19 rheumatoid arthritis, 12 non- inflammatory, 15 inflammatory, 14 infective, 7 tubercular, 4 traumatic, 6 osteoarthritis, 5 crystal induced arthritis, 6 non- specific arthritis and 8 normal cases. Accuracy, sensitivity, specificity, PPV and NPV of cell count were 76.19%, 72.72%, 94.11%, 98.46% and 40% respectively and accuracy, sensitivity, specificity, PPV and NPV of gross examination were 71.42%, 68.18%, 88.23%, 96.77% and 34.88% respectively. The individual parameters of synovial fluid study overlaps among each other test modalities and a combination of test procedures would yield better performances for diagnosis.

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.

Introduction: Preeclampsia is a hypertensive disorder during pregnancy which may severely impact the health of mothers and their newborns. The newborn of preeclamptic mother should be carefully monitored and managed for the purpose of reducing perinatal mortality and morbidity. Aim of the Study: The aim of this study was to evaluate the changes in cord blood total count of WBC and absolute neutrophil count 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 from each newborn was collected in EDTA tube after delivery and haematological test for total WBC count and absolute neutrophil count was done. 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: In this study, the mean (±SD) maternal systolic blood pressure of the study group A and control group B were 173.00 ± 19.73 and 114.83 ± 11.72 mm Hg respectively. In this study, the mean (±SD) maternal systolic blood pressure was significantly (p<0.001) higher in group A in compared to group B. The mean (±SD) maternal diastolic blood pressure of the study group A and control group B were 108.33 ± 9.52 and 73.33 ± 9.07 mm Hg respectively. In this study, the mean (±SD) maternal diastolic pressure was significantly (p<0.001) higher in group A in comparison to that of group B. The mean (± SD) total count of WBC was 9.62 ± 1.86 × 103/µl and 17.38 ± 3.31 × 103/µl in group A and B respectively. In this study, the mean (±SD) total count of WBC was lower in group A in comparison to that of group B which was statistically significant (p<0.001). In this study, mean (±SD) Absolute Neutrophil Count (ANC) was 5.76±2.01 ×103/µl and 10.45±1.90 ×103/µl in group A and B respectively. In this study, the mean (±SD) absolute neutrophil count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.953) with total count of WBC in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.957) with total WBC count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.951) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.953) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Conclusion: The total WBC count and absolute neutrophil count in the cord blood of the newborn of preeclamptic mother were lower than those of healthy pregnant mother, but they were within the normal range, it can be inferred after studying the study's findings. These changes were significantly related to severity of maternal blood pressure.

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: 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.

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.

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Chronic osteoarthritis of the pastern joint has a significant role in affecting the musculoskeletal system and is a recurrent cause of lameness in the equine athlete manifested by chronic lameness and thorough clinical and radiographic examination. This case report describes the evolution of chronic proliferative ossified osteoarthritis and periarthritis of the proximal interphalangeal joint of the front limb of a 12-year-old gelding. The careful clinical examination aimed to detect the site of the lesion, which is then confirmed by radiography that revealed extensive periarticular new bone formation over the proximal interphalangeal joint. This affection causes progressive deterioration of articular cartilage, accompanied by bone and soft-tissue periarticular changes. Control radiographic examination after a period of 10 months showed the extension of the lesion and the severe appearance of bone evolution and several medical approaches have been undertaken without improvement of the clinical condition of the horse. Several medical therapies are used in synergy with the palliative goal of reducing lameness and relieving pain, but most are of limited duration and do not stop the negative progression of the disease process. Once joint damage is advanced, it is difficult to remedy.

Eosinophilic colitis is a rare condition included in the groupof eosinophilic gastrointestinal disorder, that are charac-terized by a high eosinophilic infiltrate in the gut wall, withoutevidence of other causes [1]. We report in this case the clinical presentation as well as the macroscopic and histological aspect of this pathological entity in adults.

Objective: Study aimed to describe the effect of dexamethasone pulse therapy by assessing its efficacy on patients infected with COVID-19 complicated with MIS-C. Methods: This is single center, retrospective case series study that was conducted in Saudi Arabia. We report all eligible patients who diagnosed with MIS-C and received pulse therapy of dexamethasone during COVID-19 pandemic from 2020-2022. The study endpoints were success to wean or extubate the patient and discharge from the PICU. Results: Three patients were included in this report. All three patients received dexamethasone pulse therapy were successfully improved. After five to seven days were discharged from PICU. Conclusion: Our clinical experience suggests that the efficacy of dexamethasone with MIS-C as alternative to methylprednisolone could be effective.

Background: Sacrococcygeal teratoma (SCT) is a relatively uncommon germ cell tumor and affecting neonates, infants as well as children with a female preponderance. Age is an important predictor of malignancy in SCT. Early diagnosis and management can provide better outcome. Histologically most of the cases are benign in nature. Aim: Since there have been paucity of sufficient studies in this field in Bangladesh. The present study was carried out to describe in various clinicopathological features and histopathological findings of SCT patients. Materials and Methods: The study included 66 patients of SCT operated from 2015 to 2021. A retrospective review of different clinical information and histopathological findings was done from the radiological and pathological records available in the Bangladesh Shishu Hospital & institute, Dhaka. Result: There were 44 females and 22 males with age ranging from newborn to 08 years. Forty two children (63%) presented in the neonatal age group. Most of the cases (39) have a size of 5-10cm in diameter. There were 66.66% cases of benign (mature), 10.60% immature and 22.72 malignant teratomas. Conclusion: Predominant cases of SCT are benign in nature histologically and have an excellent outcome after early diagnosis and surgery as well as reducing morbidity and mortality. Delayed presentation and the presence of malignant changes continue to be poor prognostic factors.

Background: Patient satisfaction is a crucial aspect of healthcare, as it not only affects the overall quality of care but also influences patient outcomes and hospital reputation. Nurse-Initiated Rounds are when nurses take the lead in patient care rounds, which can help to enhance patient satisfaction by delivering more customized care and attention. Collaborative pharmacist involvement, on the other hand, can help enhance medication management and eliminate medication errors, resulting in higher patient satisfaction. Therefore, the purpose of the study was to evaluate the impact of Nurse-Initiated Rounds with Collaborative Pharmacist Involvement on patient satisfaction. Methods: A clinical trial using a non-equivalent control group design was used in the study by involving 68 participants from the hospital medical and surgical wards. The participants were assessed using the Newcastle Satisfaction with Nursing Scale and a tool to measure patient satisfaction with pharmaceutical care. The study group received the Nurse- initiated rounds of collaborative pharmacist involvement. The data were analyzed by using descriptive and inferential statistics. Results: The study reported that the experimental group, which received nurse-initiated rounds with collaborative pharmacist involvement, demonstrated significantly higher levels of patient satisfaction compared to the control group on various aspects of nursing care and pharmaceutical care. The experimental group's mean score on the first day was 6.06 (SD=0.531), whereas the control group's was 4.75 (SD=1.578). Conversely, the experimental group scored 8.21 (SD=0.632) on the fifth day of hospitalization, compared to 5.76 (SD=2.227) for the control group. Conclusion: The study findings concluded that nurse-initiated rounds with collaborative pharmacist involvement resulted in in higher satisfaction, improved drug management, and better patient care and attention. The findings also emphasized on importance of inter-professional collaboration and patient-centered care in improving satisfaction levels and overall healthcare outcomes.