Hepatotoxicity can potentially arise in hospitalized patients with Candida infections due to antifungal medications. Ongoing research has focused on the hepatotoxicity profiles of fluconazole and anidulafungin. Nevertheless, a limited number of studies have directly compared the hepatotoxicity of these two antifungals. This study compares the hepatotoxic effects of anidulafungin and fluconazole in patients hospitalized with Candida infections. This retrospective study was conducted at the Prince Mohamed Bin Abdelaziz Hospital in Saudi Arabia to compare the hepatotoxicity of fluconazole and anidulafungin in patients with Candida infection. The liver function test results were analyzed using linear mixed models, with adjustments made for confounding factors. The investigation comprised 202 cases, of which 85 (42%) were treated with fluconazole and 117 (58%) was treated with anidulafungin—mortality and prevalence of candidemia and septic shock in the Anidulafungin group (p 0.001). There was no significant difference between the two groups regarding age, gender, duration of treatment, or concomitant use of hepatotoxic drugs. Analyses utilizing Linear Mixed-Effects Models revealed higher alanine aminotransferase (ALT) (p = 0.001) and aspartate aminotransferase (AST) (p = 0.001) levels in the Anidulafungin group initially; however, after adjusting for covariates, these differences were no longer statistically significant. The levels of alkaline phosphatase (ALP) and gamma-glutamyl transferase (GTT) did not differ significantly between groups after controlling for confounding variables. However, the Anidulafungin group had substantially higher bilirubin levels than the Fluconazole group, and this difference remained significant after adjusting for potential confounding variables (p = 0.022). In summary, this study contributes to understanding the relative hepatotoxicity of anidulafungin and fluconazole. After controlling for confounding variables, it was found that there were no significant differences in liver enzyme levels between the two groups. When assessing the hepatotoxicity of these antifungal agents, it is imperative to consider the individual patient characteristics, underlying health conditions, and concurrent administration of other hepatotoxic medications.

Background: Cerebral Palsy (CP) is a prevalent motor disability affecting children globally, emphasizing the need for early identification and intervention. The Rapid Neurodevelopmental Assessment (RNDA) offers a comprehensive approach to predict CP and other motor developmental trajectories in high-risk neonates. Objective: This longitudinal cohort study aims to evaluate the effectiveness of RNDA in predicting CP and motor developmental trajectories. Method: Seventy term neonates from Dhaka Shishu (Children) Hospital were included, with neurodevelopmental assessments conducted using RNDA. Assessments were performed at 3 months and 6-9 months, with CP evaluation at 12 months using clinical examinations. Results: Prolonged labor (44.3%) and delayed cry after birth (31.4%) were common among the study patients (n=70), with varying modes of delivery including normal vaginal delivery (50.0%), vaginal delivery with complications (12.9%), and lower uterine cesarean section (37.1%). Muscle tone, primitive reflexes, gross and fine motor skills, epilepsy, and microcephaly were evaluated across visits to identify impending CP. Significant associations were found between hypertonicity, primitive reflex impairment, gross motor impairment, and fine motor impairment with impending CP across visits, particularly in the 3rd visit (p<0.05). Sensitivity, specificity, accuracy, and predictive values varied across parameters and visits, with fine motor skills and gross motor skills showing the highest sensitivity in the 3rd visit (86.4% and 100.0%, respectively). Additionally, abnormal EEG, USG of the brain, and MRI findings were significantly associated with impending CP, with USG of the brain demonstrating the highest sensitivity (93.3%) and MRI showing the highest specificity (70.0%). Conclusion: RNDA emerges as a valuable tool for early prediction of CP and motor developmental trajectories in high-risk neonates. Early identification through RNDA facilitates timely interventions, optimizing long-term neurodevelopmental outcomes.

Background: Since the pandemic of COVID-19 started from December 2019, remarkable numbers of infections and deaths associated with COVID-19 have been recorded worldwide. Chronic kidney disease patients are particularly at high risk of infections due to impairments in the innate and adaptive immune systems. Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against this specific pathogen. COVID-19 prevention through successful vaccination is therefore paramount in chronic kidney disease population. But vaccination efficacy is diminished in these patients because premature ageing of the immune system and chronic systemic low- grade inflammation are the main causes of immune alteration in these patients. Therefore, it is urgently necessary to establish a different vaccination strategy for chronic kidney disease and dialysis patient in terms of the dose and administration time. Aims: This study aimed to assessment of antibody titers after vaccination against SARS-COV-2 in patients with chronic kidney disease stage 4, 5 on conservative management and maintenance haemodialysis. Methods: This prospective observational comparative was conducted in Nephrology department of Dhaka Medical College Hospital. Selectionof patients was done by purposive sampling according to inclusion and exclusion criteria. Total 135 patients distributed in three groups: 45 patients of chronic kidney disease (CKD) stage 4, 5 on conservative management, 45 patients on maintenance haemodialysis (MHD) and 45 healthy controls were approached for the study who were receiving SARS-COV-2 vaccination. Demographic, clinical and laboratory data were collected initially. At first a pre vaccination sample or 1st sample was taken for antibody measurement. Then participants from all groups were given 2 doses MODERNA vaccine containing 100 µg in 0.5 ml each in 28 days apart. Then after 14 days of 1st dose of vaccination the 2nd samples were taken, 3rd samples were taken 14 days after the 2nd dose vaccination. Study populations were subdivided into two groups according to pre vaccination SARS-COV-2 antibody titer; seropositive- positive response before vaccination and seronegative- negative response before vaccination. They were also divided into two groups according to quantitive antibody response; positive response- values ≥10 DU/mL were positive Negative response- values of <10 DU/mL were negative. Result: Seroconversion rate was around 20% among study participants before vaccination. 14 days after the 1st dose of vaccination, 90.04% patients had positive immune response in CKD stage 4, 5 on conservative management group whereas in MHD group 84.82% responded to vaccination and immune response in control group was 100%. Immune response is 100% among all the groups after 14 days of 2nd dose of vaccination but the concentration of antibody differs significantly among the study groups. Responders were comparatively younger with normal BMI. Conclusion: Haemodialysis patients as well as patients with chronic kidney disease stage 4, 5 on conservative management showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up.

Introduction: Supracondylar fractures of the distal humerus, occurring just above the elbow joint, are the most common pediatric fractures around the elbow, accounting for 60-70% of all elbow injuries in children. Methods: This prospective observational study, conducted from June 2023 to May 2024 at NITOR, Dhaka, Bangladesh, focuses on managing displaced supracondylar fractures (Gartland Type-III) in children. Result: The average age of the patients in the study is reported as 6.5 years. The number and percentage of male and female patients are presented, with a total of 17 males (56.7%) and 13 females (43.3%) respectively. The average time for radiographic healing of the fractures was 5.2 weeks. Satisfactory radiographic outcomes were observed in 28 patients (93.3%), indicating favorable radiographic evidence of fracture healing and alignment. K-wires were typically removed around the 1-month mark postoperatively, once radiographic healing was confirmed and satisfactory outcomes were achieved. Conclusion: In conclusion, our study supports the efficacy and safety of closed reduction and percutaneous cross K-wire fixation for treating displaced supracondylar fractures of the humerus in children.

Introduction: Obesity is a major health problem in western society with rapidly increasing prevalence in most countries. The healthcare burden of obesity is far reaching but many of the consequences are yet to be fully understood. While there is a perception that obesity negatively impacts on health and stone formation in gall bladder there is conflicting evidence for this. Aims & Objectives: To assess whether obesity impacts on the blood cholesterol level which leads to dislipidaemia and gall stone formation. To identify whether dislipidaemia causes cholelithiasis and cholecystitis among obese patient. Methods: Between 1st December, 2018 and 31thMay, 2019, patients admitted in dept of surgery at Shaheed Ziaur Rahman Medical College Hospital in Bogura, Bangladesh were enrolled. Following informed consent, BMI was assessed. High risk patients and complications were identified according to established criteria. Patients were grouped according to BMI categories as Normal, overweight, Obese grade-I and Obese grade-II. Various disease of gall bladder including stone formation and its complications were analysed on all obese patients treated at Shaheed Ziaur Rahman Medical College Hospital using a SQL database. Results: Total 59 people were available and consented for this study. 09 patients were excluded; 4 patient were obese but no cholelithiasis or cholecystitis, 3 patients were not agree to investigations and 2 patients declined study). The remaining 50 patients, 29 females and 21 males, included for analysis. The median age was 48 with a range from 18-55. A literature review found evidence of increased risk of dyslipidemia which induce stone formation in GB and inflammation of gall bladder associated with obesity. Conclusion: It is an important issue that obesity is increasing in our new generations. This study should take into account for the future health care researcher. This study has summarized the current body of literature and added to it by demonstrating in our cohort that obese patients were at increased risk of formation of gallstones. I have also provided the evidence that patients with increased BMI with cholelithiasis or cholecystitis or other comorbidities are associated with significantly greater cost to the healthcare system.

Central venous catheter (CVC) is an essential tool for monitoring hemodynamics and intravenous access in many healthcare settings and, by far, most in a dynamic environment such as the operating room. It's one of the most frequent invasive procedures performed by clinicians in their practice. The literature describes many different approaches that use anatomical landmarks. However, Practice guidelines published in 2020 by the American Society of Anesthesiologists recommend the confirmation of a guide wire and central line insertion in the vein by real-time ultrasound US. This recommendation has significant practical implications, as it can lead to a reduction in adverse events following the CVS insertion. A large multicentre cohort study done in 2022, after implying the use of ultrasound-guided, reviewed the rate of adverse events following the CVS insertion and identified a variety of reasons linked with higher complication rates. A recent randomized trial compared techniques used in central line was conducted on neonates coming to the operating room who had CVS catheter placement done by pediatric anesthesiologists concluded that the modified technique was superior in regards to time efficiency and safety. This article aims to review basic knowledge and recent relevant literature about the topic in order to provide anesthesiologists with a deeper understanding of it while performing the procedure.

Background: Effective communication between primary healthcare centers (PHCCs) and referral hospitals is critical for ensuring the continuity and quality of patient care. Referral letters and feedback reports are essential for this communication, yet their quality is often inconsistent, potentially impacting patient outcomes. Study Aim: To assess the standard of feedback reports from referral hospitals and the quality of referral letters from PHCCs within the first health cluster in Riyadh. Methodology: This cross-sectional study randomly selected 360 referral letters and feedback reports from nine PHCCs in the first health cluster in Riyadh. Systematic sampling was employed to select approximately 55 documents from each center. Each document was evaluated based on 16 key components as per the Quality Assurance Manual of the Ministry of Health, using an author-developed scoring system. Results: The study included 360 referral letters and feedback reports, with an average quality score of 13.2 ± 1.5 out of 16. A majority of the documents (253, 70.3%) scored 13 or higher. Key components such as general information and patient file numbers were present in all documents (100%). Vital signs were documented in 351 cases (97.5%), and the reason for referral in 327 cases (90.8%). However, investigation results and current treatment details were included in only 142 (39.4%) and 150 (41.7%) of the documents, respectively. Clear handwriting was observed in 262 reports (72.8%), while 98 (27.2%) had legibility issues. Conclusion: The overall quality of referral letters and feedback reports in the first health cluster in Riyadh is relatively high. However, significant gaps were identified in the documentation of investigation results, current treatment details, and clinical examination findings. Addressing these gaps through targeted training, standardized documentation practices, and the adoption of electronic health records can enhance the quality of patient referrals and improve care continuity and outcomes.

Objectives: To compile the recent literature's findings and shed light on knowledge of healthcare personnel about the use of opioids in pain management. Methods: A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, SCOPUS, and Science Direct was conducted to find pertinent literature. Results: Ten studies, including a total of 58,234 participants and 21,769 (37.4%) of them were females, were included in our data. There were notable differences found between the clinical skills of physicians in managing pain and prescribing opioids and their self-perceived knowledge in these areas. Many studies reported that nearly half of the participants had poor knowledge about using opioids for pain management. Physicians with higher clinical knowledge ratings prescribed fewer opioids. Only two studies reported that professionals with advanced degrees were found to have a sufficient level of understanding regarding pain and opiate use. Conclusion: This study demonstrated a lack of and insufficient knowledge about opioids on pain management among healthcare personnel. Prospective investigations ought to concentrate on crafting customized instructional curricula and decision-assistance instruments for primary care practitioners, as well as analyzing the influence of interdisciplinary pain treatment groups on patient results.

The burden of inflammatory bowel disease is rising globally, including in the Middle East. There is a paucity of real-world data related to the disease and its treatment in many countries in this region. Patient registries can provide real-world evidence of disease incidence and aetiology, treatment and patient outcomes. The authors designed a non-interventional, multicentre registry to evaluate treatment pathways, resource consumption, and clinical outcomes of patients with inflammatory bowel disease in the Middle East. This article describes challenges faced, and lessons learned from setting up the registry. Registry development requires time, effort, expertise, and skills development to be functional and meet international standards. Careful consideration of legal, governance, ethical and financial issues; data protection and control, minimum data set, data quality assurance, data collection methods, inclusion criteria as well as data sources is critical to the development process. Our findings present stakeholders with a guide for the development and implementation of future registries in the Middle East and offer valuable lessons learned that other countries or regions can utilise as they address inflammatory bowel disease burden and establish their own registries.

Nanotechnology involves producing nanoscale materials with specific properties. Zinc oxide nanoparticles have potential applications in various fields. Due to toxic chemicals and environmental concerns, green methods using plants, fungi, bacteria, and algae have been adopted. An emerging area of nanotechnology is the green synthesis of nanoparticles using biological systems, particularly seaweed extracts. The green synthesis method has synthesized the zinc oxide nanoparticles using the aqueous extract of the brown seaweed Sargassum ilicifolium. The algal extract has greatly reduced the zinc acetate dihydrate salt solution to form zinc oxide nanoparticles. The synthesized zinc oxide (Zn-O) nanoparticles have been confirmed through Particle Size Analyzer (PSA), Raman spectroscopy, UltraViolet (UV)- Visible (Vis) spectroscopy, and Scanning Electron Microscope (SEM). The study used Scanning Electron Microscope (SEM) and Particle Size Analyzer (PSA) to examine the size and shape of the Zn-O nanoparticles. Raman spectroscopy and UltraViolet-Vis spectroscopy confirmed the formation of Zn-O nanoparticles. The SEM results exhibited a range of 24.4 nm to 83.4 nm. The occurrence of Zn-O nanoparticles was confirmed by Raman spectroscopy with peaks at 276.98 cm-1, 414.67 cm-1, 462.03 cm-1, 514.99 cm-1, and 998.28cm-1 and UltraViolet-Vis spectroscopy with peak at 370 nm. The present study also deals with the qualitative phytochemical constituent analysis using the aqueous extracts of Sargassum ilicifolium. Alkaloids, flavonoids, cardiac glycoside, tannins, amino acids, carbohydrates, and saponins were analyzed. Anthraquinone, anthocyanin, vitamin C, quinone, and phlobatannins were considered absent in the aqueous extract.

Ustekinumab is a human monoclonal antibody typically used to treat moderate to severe plaque psoriasis, psoriatic arthritis, moderate to severe Crohn's disease, or moderate to severe ulcerative colitis (inflammatory bowel disease). Ustekinumab mediates the body's T-cell response by acting as an antagonist against interleukin-12 (IL12) and interleukin-23 (IL23). Although rare, the emergence of severe infections or exacerbation/reactivation of existing infections (bacterial, mycobacterial, fungal, viral) is possible for Ustekinumab. We report a case of a 29-year-old female patient who was prescribed Ustekinumab for Crohn’s disease management. After the commencement of the drug for two doses she developed Varicella pneumonia with ARDS which was subsequently managed.

Introduction: Upper Gastrointestinal bleeding (UGIB) is a major cause of mortality in patients with renal failure. The aim of our study is to determine the epidemiological, lesional and prognostic profile of UGIB in chronic kidney disease (CKD) patients. Materials and Methods: This was a single-center study conducted from September 2017 to August 2023, including all patients with CKD admitted to the emergency department for upper GI bleeding who underwent Esogastroduodenoscopy (EGD). The various data were collected from endoscopy registries. Results: Of 662 patients admitted via the emergency department for UGIB, 59 cases of CKD (8.9%) were included, of which 43 cases were at the hemodialysis stage (72.88%). The mean age was 57.17 years, with a male predominance (sex ratio M/F 1.55). Isolated melena was the main reason for admission in 35 cases (59.32%), followed by hematemesis with melena in 9 cases (15.25%), and hematemesis without melena in 10 cases (16.94%), while massive rectal bleeding was present in 5 cases (8.47%). Esogastroduodenoscopy established the etiological diagnosis of UGIB in 40 cases (67.8%) and revealed the following lesions: 25 cases of peptic ulcer (62. 5%):2 cases (8%) of antral gastric ulcer,1 case (4%) of Forrest IIc bulbar ulcer, 12 cases (48%) of Forrest III bulbar ulcer and 10 cases (40%) of ulcerative bulbitis, 12 cases (30%) of gastric and duodenal angiodysplasia, 2 cases (5%) of Los Angelos grade B and C esophagitis and 1 case (2. 5%) of grade II of oesophageal varices ligatured in an unknown patient with portal hypertension. EGD was negative in 32.2% of cases. Conclusion: Upper GI bleeding is common in patients with chronic renal failure and is primarily caused by peptic ulcer disease and angiodysplasia.

Objectives: To thoroughly evaluate the incidence, outcomes, and associated risk factors of trauma among children attending emergency departments in Saudi Arabia. Methods: A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, SCOPUS, and Science Direct was conducted to find pertinent literature. Results: Ten studies, including a total of 2351 children who had various traumas, and 1705 (72.5%) of them were males, were included in our data. Cervical spine injuries occurred mainly due to blunt trauma, and the majority improved. MRI can shorten the time needed to clear the cervical spine and lower the number of injuries that are overlooked. Ocular traumas were reported in two studies, one due to chemical burns and the other due to fireworks. The two mechanisms left permanent complications, such as corneal opacity and limbal stem cell deficiency. Multiple traumas (such as fractures lacerations, burns, and brain injuries) that occurred due to falls, MVA, blunt traumas, and penetrating wounds. Most cases were stable and survived with no significant disability. Conclusion: Even with an increased risk, children rarely suffer serious injuries. Children displayed the many forms of trauma and its associated affective aspects. Ocular traumas held the most serious and life-threatening complications. Because there are many elements that contribute to trauma, it is advised that appropriate interventions and preventive measures be used in order to minimize trauma.