Background: Chronic subdural hematoma (cSDH) remains a significant neurosurgical challenge, with ongoing debate regarding optimal surgical management. This study compared the outcomes of burr hole craniostomy (BHC) versus minicraniotomy (MC) in treating cSDH. Methods: A retrospective analysis of 100 consecutive patients with unilateral cSDH was conducted between October 2022 and January 2024. Patients were divided into BHC (n=49) and MC (n=51) groups. Outcomes were assessed using the Landriel Ibañez grading system for complications, recurrence rates, and 30-day mortality. Results: Mean patient age was comparable between groups (BHC: 72.6±14.2 years, MC: 72.9±12.4 years). Overall complication rates were lower in the BHC group (14.3% vs 21.6%), while recurrence rates were higher (12.2% vs 5.9%, p=0.09). The 30-day mortality rates were similar (BHC: 2.0%, MC: 1.9%, p=0.50). Neurological outcomes were comparable, with mean GCS scores at discharge of 14.4 and 14.3 for BHC and MC groups respectively (p=0.07). Grade Ib complications were most common in both groups (BHC: 6.1%, MC: 9.8%). Conclusion: While both techniques demonstrated acceptable safety profiles, BHC showed lower complication rates but higher recurrence tendency, whereas MC exhibited lower recurrence rates but higher complications. These findings suggest that surgical approach selection should be individualized based on patient characteristics and hematoma features.

Background: Ventriculoperitoneal shunt procedures remain the mainstay of hydrocephalus treatment despite significant complication rates. This study analyzed the patterns and risk factors for shunt complications in a tertiary care setting. Methods: A prospective observational study of 80 patients undergoing VP shunt surgery was conducted. Patient demographics, etiology, and complications were analyzed using standardized protocols. Results: The study included 50 males (62.5%) and 30 females (37.5%), with 57.5% under one year of age. Congenital hydrocephalus (37.5%) and tubercular meningitis (18.75%) were the predominant etiologies. Overall complication rate was 20%, with obstruction (11.25%), infection (6.25%), and displacement (2.5%) being the main complications. Ventriculitis cases showed the highest complication rate (37.5%, p<0.05). Conclusion: While VP shunt complications remain significant, certain etiologies carry higher risks. Understanding these patterns can improve patient selection and management protocols.

There is considerable evidence that most (if not all) malignant tumors utilize immunomodulatory proteins that result from activating membrane progesterone receptors (mPRs) in males as well as females. Support for this concept has been provided by the demonstration that treating people with a variety of different cancers that are very advanced with no more standard or even clinical trial options to have a considerable extension of life (in several instances even more than 5 years with death unrelated to their cancer) by treatment with single agent oral mifepristone a PR receptor antagonist. Just as important, most patients, even when the cancer has damaged vital organs, so a marked extension of life is not possible, are able to experience considerable palliative benefits. Presented is a case of an 85-year-old male whose end stage cardiomyopathy was complicated by a 5.5 cm cholangiocarcinoma with lymph node metastasis. Rather than the suggestion of hospice to end life within 2- 3 weeks, or starting chemotherapy, he chose the option of mifepristone therapy. So far, he has experienced 4 months of a decent quality of life. The purpose of presenting his case is not only to introduce another type of cancer that responds to PR antagonists that has never been reported before, but to introduce this type of therapy for advanced cancer that despite many publications and presentations at scientific meetings, probably because there are no commercial interests, this highly effective therapy is relatively unknown, it may be especially of interest to countries, e.g., India and China, where mifepristone is available at a much lower price than in many other countries. The cost of healthcare could be markedly reduced by simply offering oral mifepristone to patients with advanced cancer and no need to monitor subsequent potential adverse effects because it has a very high safety profile when used at a lower dosage of 200mg/day. Thus, besides just a fraction of the cost of chemotherapy agents or immunotherapy, there would be considerable savings for cost of hospital admissions to treat the complication of most standard cancer therapeutic options.

Introduction: Allergic rhinitis, or allergic rhinosinusitis, is characterized by inflammation of the nasal mucosa leading to paroxysms of sneezing, rhinorrhea, and nasal obstruction, often accompanied by itching of the eyes, nose, and palate. The clinical manifestation recurs after each exposure to the initiating allergen. Methods: This research is descriptive type with a cross-sectional study was carried out at Dept. of ENT, BSMMU, Dhaka, Bangladesh from July 2022 to August 2023. Total 60 patients included in our study. The highest range of age in the 18-49 years. The sampling technique in this research was sequential (consecutive sampling). The type of data used is primary data including name, age, gender, symptoms of allergic rhinitis, clinical manifestations, questionnaire scores on allergic rhinitis. Results: From 60 patients, numbers of male and female in the subjects’ general characteristics were mostly women (55%) with the highest range of age in the 18-34 age group (36.6%), followed by 35-qwsa 49 age group (30%). A majority of the subjects were school/ college students (33.3%) and private employee (30%). In this study, the most sufferers were moderate to severe persistent allergic rhinitis, namely 47 people (78.3%), followed by mild intermittent 12 people (20%). Allergic shiner is the result of inspection of the most common signs of allergy on the face found in this study (83.3%), while allergic creases were only found in 2 respondents (3.3%). The most common symptoms are: nasal obstruction of 52 people (86.6%), followed by rhinorrhea with 46 people (76.6%). Most of the study subjects present with comorbidity (100%) with rhinosinusitis as the highest frequency (55%). Conclusion: This research is allergic rhinitis patients, in particular the Sub-Allergy Immunology at with the hope that the treatment management algorithm is appropriate and provides clinical improvement in both signs and symptoms of rhinitis patients.

Contractile function is primarily determined by the myosin heavy chain (MyHC). The β-isoform is the most often expressed in human ventricular cardiomyocytes (CMs). We previously showed that following long-term incubation on glass coverslips covered with laminin, approximately 80% of human embryonic stem cell-derived cardiomyocytes (hESC-CMs) express just β-MyHC. In order to characterise cellular function, we examined the effects of enzymatically separating hESC-CMs following prolonged growth and then replating them. In a micro-mechanical setting, we found that force-related kinetic characteristics reflected variations in calcium transients and resembled α- rather than β-MyHC-expressing myofibrils. According to single-cell immunofluorescence analysis, replating hESC-CMs caused α-MyHC to be rapidly upregulated, as evidenced by increases in hESC-CMs that expressed α-MyHC solely and α/β-MyHC mixed. Individual CMs generated from human induced pluripotent stem cells (hiPSCs) similarly showed a similar increase in the variability of MyHC isoform expression following replating. During the second week following replating, the alterations in cardiomyocyte function and MyHC isoform expression brought on by replating were reversible. The expression profile of genes and pathways relevant to mechanosensation/transduction, particularly integrin-associated signaling, changed, according to gene enrichment analysis based on RNA-sequencing data. Thus, focal adhesion kinase (FAK), an integrin downstream mediator, enhanced β-MyHC expression on a rigid matrix, thereby confirming gene enrichment analysis. In conclusion, long-term cultivated human stem cell-derived CMs underwent significant changes in gene expression, MyHC isoform composition, and function as a result of detachment and replating. This led to changes in mechanosensation/transduction, which should be taken into account, especially for subsequent in vitro tests.

Objective: Although the effectiveness and adverse effects of long-term therapy are still mostly unknown, patients are increasingly using and seeking LT4/LT3 combination treatment for persistent hypothyroid symptoms. The purpose of this study was to assess the quality of life (QoL) and hypothyroid symptoms of the patient group that was affected by LT4/LT3 in a long-term manner. Methodology: A cross-sectional study of 66 hypothyroid patients who had starting LT4/LT3 combination medication earlier was conducted. The patients were divided into two groups based on their current treatment: T3 responders, who were still getting LT4/LT3 treatment, and T3 non-responders, who had stopped LT3 treatment since it was not working. Hypothyroid symptoms were measured using a validated symptom score, and QoL was assessed using ThyPRO. The article presents a real-world study that shows dissatisfied people being treated at an outpatient clinic. Results: The subjects started LT4/LT3 combination therapy 5.4 years ago, and their median age was 56. Twelve patients stopped LT3 treatment because it was ineffective, whereas fifty-four patients remained to undergo LT4/LT3 therapy. The QoL of the patients in the T3 responder group was similar to that of the background population. Remarkably, the T3 responder group's symptom scores were comparable to those of Nepalese women with overt hypothyroidism. In the T3 responder group, 38% of patients had thyroid stimulating hormone (TSH) levels below 0.4 mU/L, which suggests over-treatment. Conclusion: Patients still had numerous symptoms even though LT4/LT3 medication was well-tolerated, had no adverse effects, and had a great quality of life.

The liver is a metabolically adaptable organ that is essential for controlling blood glucose and cholesterol levels. Fatty acids (FAs) are continuously flowing into the liver from a variety of sources, such as dietary sources, adipose tissue, endogenous synthesis from non-lipid precursors, intrahepatic lipid droplets, and recycling of triglyceride-rich leftovers. Triglycerides, which can be oxidised, stored, or released into the bloodstream as very low-density lipoproteins, are produced in the liver using FAs. Many factors can influence intrahepatic FA partitioning, and while there is good evidence that both phenotype (e.g., sex, ethnicity, and adiposity) and dietary macronutrient composition can play a role in intrahepatic triglyceride accumulation, their interaction is still poorly understood. The processes of FA uptake, FA synthesis, and the intracellular partitioning of FAs into storage, oxidation, or secretory pathways are tightly regulated; an imbalance in these processes leads to intrahepatic triglyceride accumulation and is linked to the development of metabolic dysfunction-associated steatotic liver disease. This review's objectives are to investigate how phenotypes affect the delivery, synthesis, and disposal of FAs and to comprehend how the makeup of dietary macronutrients may affect how FAs are partitioned in the human liver in vivo.

Galactorrhea is defined as milky discharge from breast in men or women who are not breastfeeding for more than one year. It may result from excessive secretion of prolactin from anterior pituitary or from increased sensitivity of breast tissue to prolactin. There are many causes of hyperprolactinemia and galactorrhea and the most sinister being pituitary tumours. Occasionally certain drugs can cause hyperprolactinemia leading to galactorrhea and irregular menstrual cycles. Levosulpiride which is commonly used for its antiemetic and antidyspeptic actions can also rarely cause hyperprolactinemia and galactorrhea. We present a case of galactorrhea in a female of 35 years who was on treatment for dyspeptic symptoms with a combination of pantoprazole and levosulpiride, which subsided after stopping the offending drug. Critical review of prescription in dealing with a case of galactorrhea can avoid unnecessary investigations.

Context : One of the most important public health issues in the world is hypertension. Hypertension was responsible for approximately half of the 2008 cardiovascular disease-related deaths. One of the main obstacles to avoiding complications and the future burden of cardiovascular illnesses is bringing blood pressure down to a normal range. Determining the prevalence, awareness, treatment, and management of hypertension and its contributing variables in Nepal is the goal of this study. Methods : This community-based cross-sectional study was carried out in Kathmandu, Nepal, as a component of a community-based intervention experiment. 1159 participants who were at least 30 years old were enrolled. Four wards were chosen at random from a total of twelve wards (administrative units). From each chosen ward, three hundred individuals were gathered. Using standard STEPS questions, a trained enumerator gathered clinical, anthropometric, and sociodemographic data. Results : Women made up 71% of the total participants, and their mean age was 47±12.6 years. The prevalence of hypertension was 40.6% when age and sex were taken into account, compared to 38.9% (95% CI: 36–41.7) overall. Of the women, 35.2% (95% CI: 32.4–37.9) and 48.1% (95% CI: 45.2–50.9) had hypertension. Significant variables linked to hypertension were found to include male gender (OR = 1.49), older age (OR = 1.04 each year), Dalit caste (OR = 1.71), history of cigarette smoking (OR = 2.78), current alcohol use (OR = 1.75), and elevated body mass index (OR = 1.17 per unit). Of the respondents with hypertension, 53.4% (95% CI: 48.7–58) were aware, 29% (95% CI: 24.8–33.1) were undergoing therapy, and 8.2% (95% CI: 5.6–10.7) had blood pressure under control. Conclusion : According to the study, hypertension is quite common in Nepal but is not well understood, treated, or controlled. Hypertension was linked to body mass index, smoking, consuming alcohol, age, gender, and ethnicity. To lessen the burden of cardiovascular diseases in the future, immediate public health and personal actions are necessary

Background: Infection control in dentistry is a critical aspect of clinical practice due to the continuous emergence of transmissible infectious agents. Cross-infection remains a significant concern, particularly through aerosols, bloodborne pathogens, and contaminated dental unit waterlines (DUWLs). Compliance with infection control protocols is essential to minimize occupational risks. This study assesses the awareness and adherence to cross-infection control measures among dentists in their workplace in Bhopal City. Materials and Methods: A descriptive cross-sectional study was conducted among 312 dentists practicing in solo, group, and hospital-based settings in Bhopal City. A structured, pre-validated questionnaire was distributed online, covering aspects such as demographic characteristics, awareness of cross-infection control, preferred preventive measures, sterilization practices, and concerns regarding infection risks. The data were analyzed using SPSS Version 29, with statistical significance set at p ≤ 0.05. Results: Out of 312 participants, 175 (56.1%) were female and 137 (43.9%) were male. The majority (51.6%) were clinical specialists, while 48.4% were general practitioners. Among the respondents, 51.0% practiced solo, 14.1% worked in group clinics, and 34.9% were in hospital-based settings. The study found no significant difference in infection control awareness across gender, professional status, or practice type. A high proportion of dentists (88.8%) consistently followed universal precautions, while 93.3% reported strict adherence to avoiding exposure to sharp devices. Notably, 92.3% of respondents expressed concern about cross-infection risks, and 85.9% recognized the role of high aerosol suction in minimizing contamination. However, 31.4% lacked awareness of cross-infection protocols, and 11.2% had not been vaccinated against hepatitis B. Conclusion: The study indicates a high level of awareness and compliance with infection control measures among dentists in Bhopal. However, gaps exist in practices like high-volume suction use, handpiece sterilization, and waste disposal. Regular training and audits are crucial for improved adherence.