Stentolith also known as stent-stone complex of common bile duct is rare long -term complication of forgotten or retained stent. Most common long-term complication of retained common bile duct stent is cholangitis with stone. We reported a 60 years old female presented with cholangitis and having history of ERCP and laparoscopic cholecystectomy 7 and 5 years ago respectively. MRCP shows dilated CBD, CHD, central and peripheral IHBR with a tubular filling defect of 8.2 cm in CHD, CBD and extending up to 2nd part of duodenum and also a small filling defect in cystic duct remnant. Patient underwent for open CBD exploration. Retained stent and multiple stones are removed. She had an uneventful post-operative course. Patient should be advised for regular follow up and stent removal after 6 weeks..

Hepatic encephalopathy is a serious complication of chronic liver disease characterized by the presence of various states of altered mental status, ranging from mild alteration in sleep wake cycle to obtundation and deep coma.

Minimal hepatic encephalopathy is defined as early stage of hepatic encephalopathy without symptoms on clinical and neurological examination but with mild cognitive impairment and attention deficits.

Various combination of psychomotor test has been assessed for their use in diagnosis of minimal hepatic encephalopathy.

Aim: To study the Proportion of patients presenting with minimal hepatic encephalopathy in cirrhosis liver and also to find out the correlation between results of psychometric tests.

Result: Age Distribution of 120 patients showed majority of the patients were in age group of 31- 40 years and gender distribution showed 92.5% were males. Majority of the patients had alcoholic cirrhosis as the etiology (79.1%). Among the clinical features distension of the abdomen was the most common symptoms and among the clinical signs pallor (55%) was the most common, followed by splenomegaly (48.33%). On calculating Child Pugh’s score it was seen that 44.17% patients were in Child Class B. Minimal hepatic encephalopathy was found to be highest in Child Pugh Class B (56.6%). Patients with minimal hepatic encephalopathy with gastro esophageal varices and was found to be statistically significant (P-value <0.001).

Conclusion: The single centered cross-sectional observational hospital-based study performed with 120 cases of cirrhosis of liver without overt hepatic encephalopathy showed majority of patients have abnormal psychometric test- number connection test (NCT A), digital symbol test etc

Background: Psoriasis has a wide range of clinical presentations, unresolved etiology, association with distress, and no definitive treatment. It is very important to have a greater familiarity with the signs and symptoms of the disease so that appropriate treatment can be provided at its earliest. Therefore, this study aimed at understanding the clinical patterns & epidemiological profile of psoriasis.

Materials & methods: This observational, cross-sectional study was conducted over a duration of 18 months in the Department of Dermatology of a tertiary care hospital. The study included all the patients visiting the department who were diagnosed with psoriasis. A clinical examination and biopsy (if needed) were performed. Body mass index (BMI), age of onset, duration, patterns of skin lesions, percentage body surface area (BSA) of involvement, presence of nail psoriasis, and presence of Psoriatic arthropathy, and psoriasis area severity index (PASI)were assessed.

Results: The study included 152 subjects; most of the subjects were 21-60 years old (81.5%). Men are more likely to be affected than women. Most commonly patients present with the complaint of itching (82.4%).The mean±standard deviation of the age of onset was 33.90±14.27 years and the PASI score was 7.6475±5.88. Psoriasis vulgaris, which accounts for 69.38% of cases, is determined to be the most prevalent form of the disease, followed by palmoplantar psoriasis, which accounts for 16.25% of cases.

Conclusion: The epidemiological characteristics of psoriasis observed in this study are comparable to those observed in other parts of the world.

Adolescents rarely present with bloody nipple discharge, associated with benign breast diseases like benign phyllodes tumor and fibroadenoma. Even though they are usually benign, if there is a palpable lesion, a full investigation into the cause and course of treatment is necessary. We hereby report a case of 20-year-oldyoung girl with bloody nipple discharge who had no previous significant medical history. Breast imaging reporting and data system (BI-RADS) classified the solid, oval-shaped, circumscribed mass seen on breast ultrasonography as category III. It was located in the right subareolar region. On FNAC, it was diagnosed as Cellular fibroadenoma and was confirmed on histopathological examination. Even though bloody nipple discharge is uncommon in children, noninvasive diagnostics and image-guided treatment planning can be benefitted from ultrasound evaluation and knowledge of characteristic findings

Introduction: Soft tissue refers to non-epithelial tissue, Soft tissue is a specialized form of tissue derived from the mesenchymal component of the embryo. It includes adipose tissue, fibrous tissue, skeletal muscles, blood vessels, lymphatic vessels and peripheral nervous system and is exclusive of skin, bone, lymphoreticular system, glia and soft tissues of various parenchymal organs. Soft tissue tumors (STT) are categorized into benign, intermediate and malignant. The incidence of benign STT is higher when compared to malignant tumors.  Histopathology is considered the gold standard method for the diagnosis of soft tissue tumors. Different special stains along with Immunohistochemistry are applied to increase the diagnostic accuracy of soft tissue tumors.

Material and Method: The study was conducted on soft tissue tumors over the period from July 2022 to December 2023, with a total of 189 cases in the Department of Pathology.

Results: : A total of 189 soft tissue tumor  biopsy specimens were received in the pathology department including the age range 1 to 60 years and gender (Male/Female). Most common age group is 20-40 years (40.74%). Among them most of tumors are Benign 169(89.41%), some are Malignant 20(10.58%). The most common benign soft tissue tumor were Leiomyoma ,Lipoma , Hemangioma , Schwannoma and Lymphangioma, Angiomyolipoma, desmoid tumor, nodular fasciitis , glomangiopericytoma, benign fibrous histiocytoma. The most common benign soft tissue tumor was Leiomyoma 74(39.15%), followed by Lipoma 40(21.16%).Benign soft tissue tumors showed female preponderance with peak incidence in 3rd and 4th decade. Malignant tumor was Dermatofibrosarcoma  protuberance , malignant fibrous histiocytoma, liposarcoma, fibrosarcoma, leiomyosarcoma, smooth muscle tumor of uncertain malignant potential, epithelioid sarcoma, primitive neuroectodermal tumor, solitary fibrous tumor, undifferentiated sarcoma.

Conclusion: Benign soft tissue tumors were relatively more common than the malignant tumors. Leiomyoma was the commonest benign soft tissue tumor followed by Lipoma. Histopathological diagnosis of soft tissue tumors is important for further management of patients. Histopathological study along with IHC wherever necessary , should go hand in hand to make an effective and complete diagnosis of soft tissue tumors

Purpose: The study aimed to identify Musculoskeletal Problems among Swimmers at Sayed Nazrul Islam National Swimming Complex in Mirpur, Dhaka. Objective: The objective of this study was to find out socio-demographic information. Methodology: This study was performed in a cross-sectional study design. This study was conducted to determine the. This study's sample was collected through a convenience sampling procedure and a total sample of 52. The data was collected from Dhaka city. The data collection process was a questionnaire with a face-to-face interview. Data was analyzed with Microsoft Office and Excel 2019 using the SPSS 25 version software program and the study chi-square test. Result: This study's participants mean and standard deviation of participants' age where are mean ±SD= 21.56±3.398; About (n=35) 67.30% were less than 22 years old, (n=13) 25% were 22-26 years old and (n=4) 7.70% greater than 26 years old. And the sex of the participants (n=44), 84.60% were male, and (n=8) 15.40% were female. This study found that 30.8% of participants felt pain in their bodies, and 69.2% felt no pain in their bodies. About 43.8% claimed their neck pain, 56.3% of respondents had shoulder pain, 6.3% had elbow pain, 18.8% had back pain, 37.5% suffered from hip pain, and the rest of the 37.5% had knee pain. Then, the researcher found that (n=36) 69.2% felt no pain, (n=15) 28.8% felt mild pain and (n=1) 1.9% were moderate pain. And about 57.70% had muscle cramps. Conclusion: This study focused on swimmers' musculoskeletal problems in Dhaka. There is an urgent need for the physician and medical care for swimmers

Background The gold standard for primary and secondary prevention of cardiovascular events is low-dose antiplatelet treatment. Due to its advantageous antiplatelet qualities, aspirin has become a medication primarily used to prevent cardiovascular disease. The use of aspirin has been restricted due to its association with gastrointestinal (GI) damage, regardless of its therapeutic applications for which reasons clopidogrel is administered as a substitute. Treatment may be stopped if dyspeptic symptoms arise. The study aims to ascertain the frequency of dyspeptic symptoms in individuals on low-dose antiplatelet treatment for both primary and secondary cardiovascular event prevention in the southern part of Nigeria.

Method: The retrospective study included 291 patients’ demographic data (age, gender, antiplatelet therapy, and presenting GI effects) which were on Low-dose aspirin (LDA) and clopidogrel as antiplatelet therapy

Result: In the study, 52% of subjects were female and 45% were male, aged 16 to 94 (mean age: 55 ± 15.4 years). The majority (54.2%) fell within the 41–60 age group. Antiplatelet therapy included low-dose aspirin (27.5%) and clopidogrel (85.5%). 53.5% of subjects on clopidogrel had a medication history with the use of aspirin and 33% of subjects presented with dyspeptic symptoms which led to the use of clopidogrel instead of LDA. The remaining 13.5% of subjects reported dyspeptic symptoms on use. Dyspeptic symptoms observed included epigastric pain (26.46%), heartburn (14.43%), bloating (12.03%), and dark stools (6.87%). Dyspepsia was noted in 59.79%of patients on antiplatelet therapy in the study population.

Conclusion: Among patients on antiplatelet therapy, the high prevalence of dyspeptic symptoms emphasizes the importance of follow-up by monitoring and managing gastrointestinal side effects in these patients.

Introduction: The incidence of superficial dermatophytosis in India has notably increased over the past 5-6 years, posing a significant public health concern. According to Emmons Morphological criteria, dermatophytes fall into three anamorphic genera based on conidial morphology: Trichophyton (affecting skin, hair, and nails), Microsporum (infecting skin and hair but not nails), and Epidermophyton (infecting skin and nails but not hair). These fungi are further classified based on their habitat association into anthropophilic (affecting humans exclusively), zoophilic (infecting domestic and wild animals as well as birds), and geophilic (isolated from soil) species.

Zoophilic species typically induce highly inflammatory reactions, while anthropophilic species tend to cause milder but chronic lesions. Common dermatophyte infections include athlete’s foot (Tinea pedis) and barbers itch (Tinea barbae). Dermatomycoses refer to diseases caused by non-dermatophytic fungi affecting the skin, with piedra and onychomycoses affecting the hair and nails, respectively. Athlete’s foot and jock itch (Tinea cruris) are prevalent examples, causing severe itching and lesions in sensitive areas, often leading to social embarrassment and reduced quality of life.

The epidemiology of dermatophytes varies across countries and regions, necessitating surveillance studies to comprehend changing clinicoepidemiology and identify prevalent pathogens for effective treatment strategies. Aims: This present study was conducted to identify the clinical profile and species of dermatophytic infection at our tertiary care centre IIMSR Lucknow Uttar Pradesh India. Study design: The present study was a hospital based observative prospective study. Statistical Analysis: Statistical analysis was done using SPSS version 29.0.1.1. Chi square test and appropriate tests of significance were applied. Method: It was a hospital based observational study of 156 clinically diagnosed case of dermatophytosis during five months duration. Sociodemographic details, clinical history and detailed examination were conducted from all patients. Skin scrapings were sent to microbiology department of our hospital for direct microscopy and culture. Results: Among 156 patients enrolled males were commonly affected than females, male to female ratio was 2.6:1. Incidence was maximum in rural area 56% as compared to urban. Multiple site infection (35.9%) was found to be commonest clinical type followed by Tineacruris (16.67%). Trichophytontonsuran was the commonest isolate obtained (35.2%) followed by Trichophyton mentagrophytes (22%).The outdoor activities, such as farming, labour work and poor personal hygiene in rural area were identified as risk factor for infection. Conclusion: The present study has provided recent data on etiological agent of dermatophytosis and risk factor in tertiary care Centre. Microscopy with and without culture is an important diagnostic tool in dermatophytosis. It is important to develop measurement for disease prevention and controlalong with effective therapy.

Background: The advancement of artificial intelligence (AI) in medicine is associated with applications meant to support physicians in diagnosing patients, selecting treatments, and forecasting their results. Thanks to the quick advancement of analytical tools and the growing availability of healthcare data, it is revolutionizing the healthcare industry. Modern deep learning (DL) and machine learning approaches for structured data, such as neural networks and classical support vector machines, as well as natural language processing for unstructured data, are examples of artificial intelligence techniques. Methodology: More than 60 articles were reviewed, and 45 were selected. The literature review was conducted using the databases PubMed, Embase, Google Scholar, and Scopus. Review: Laboratory medicine uses modern technology to improve clinical decision-making, disease monitoring, and patient safety. Artificial intelligence is increasingly used in clinical microbiology informatics. Genomic data from isolated bacteria, metagenomic microbiological results from original specimens, mass spectra recorded from growing bacterial isolates, and huge digital images are all examples of massive datasets in clinical microbiology that can be used to develop AI diagnoses. Conclusion: Healthcare technological innovation is accelerating and becoming more integrated into our daily lives and medical practices, such as smart health trackers and diagnostic algorithms.

Background: With the escalating use of medications, there is a corresponding rise in non-adherence, posing a significant public health challenge. Medication adherence is crucial for treatment efficacy and it reflects the alignment of an individual's behaviour with medical advice. Thus, a study was devised to assess the prevalence of non-adherence-related medical emergency admissions, evaluate adherence frequency, identify implicated drug classes, and analyze underlying causes.

Methodology: The study was conducted over 12 months. This observational, prospective, uni-centric study enrolled patients diagnosed with non-adherence by clinicians using Morisky Green Levine Scale (MGL).

Results: Among drug-related medical emergencies, 93 cases were attributed to non-adherence, with a mean patient age of 55.26 years. Seizures emerged as the predominant chief complaint. Antihypertensives were the most commonly prescribed medications, followed by antidiabetics, antiepileptics, and anticoagulants. Notably, a statistically significant association between moderate adherence levels and unemployment was observed. (p<0.001)

Conclusion: The results of our study help identify several characteristics that can be used to identify elders at risk of suffering drug-related or non-adherence-related hospitalizations

Background: Frailty is a critical determinant of outcomes in older ICU patients, yet its prevalence and impact remain underexplored. This study aimed to assess the frailty distribution using Fried's phenotype and its association with ICU outcomes among older adults.

Methods: A prospective cohort study of 60 ICU patients aged ≥65 was conducted, categorizing patients into frail, pre-frail, and non-frail groups. Data on demographics, clinical characteristics, frailty criteria, morbidity, mortality, and ICU interventions were analyzed.

Results: Frail patients (n=36) were older (78 ± 5.6 years) and had longer ICU stays (6 ± 2.8 days, p=0.032) compared to pre-frail (n=20) and non-frail (n=4) patients. Significant differences in frailty criteria were observed, with weight loss (65%), weakness (70%), and poor endurance (60%) predominantly seen in the frail group (p<0.001 for each). Morbidity events were significantly higher in frail patients (41.7%, p=0.05), with a trend towards higher in-hospital mortality (19.4%, p=0.08) and inotrope requirement (33.3%, p=0.06).

Conclusion: Frailty significantly affects ICU outcomes, with frail patients experiencing longer stays and higher morbidity. These findings highlight the necessity of integrating frailty assessment into ICU care protocols to tailor interventions and potentially improve outcomes for this vulnerable population.

Background: Optimizing anesthesia in orthopedic surgeries is crucial for improving postoperative outcomes and patient satisfaction. Dexmedetomidine, a selective α2-adrenoceptor agonist, has been proposed as a beneficial adjunct to spinal anesthesia, offering sedative, analgesic, and hemodynamic stabilizing properties.

Methods: In this prospective comparative, 100 patients undergoing elective orthopedic surgeries were allocated to receive spinal anesthesia with either dexmedetomidine (Group D, n=50) or placebo (Group C, n=50). The study evaluated the duration of sensory and motor blockade, postoperative analgesic requirements, hemodynamic parameters, incidence of side effects, and patient satisfaction.

Results: The addition of dexmedetomidine significantly prolonged the duration of sensory (243.8 ± 35.4 vs. 192.6 ± 29.8 minutes, P<0.001) and motor blockade (196.5 ± 22.1 vs. 148.3 ± 25.6 minutes, P<0.001). Group D patients required less postoperative analgesics (134.2 ± 28.7 mg vs. 205.6 ± 33.5 mg, P<0.001) and reported a longer time to first analgesic request (14.7 ± 2.6 hr vs. 10.4 ± 2.1 hr, P<0.001). Despite an increased incidence of bradycardia and hypotension in Group D, these were clinically manageable. Patient satisfaction was significantly higher in the dexmedetomidine group (P=0.012).

Conclusion: Dexmedetomidine as an adjunct to spinal anesthesia in orthopedic surgeries significantly improves blockade duration, reduces postoperative analgesic needs, and enhances patient satisfaction, with manageable hemodynamic effects. These findings support the adjunctive use of dexmedetomidine, highlighting the importance of appropriate dosing and monitoring.

In middle-aged females, abdominal pain or discomfort with dyspepsia is a very common complaint. The cause of abdominal pain can vary from hepatobiliary, genitourinary, intestinal, or even functional. Clinical history and examination findings help the clinician with potential diagnostic clues and further management. But even after comprehensive workup, sometimes diagnosis remains uncertain though the proportion of such patients in the above subset of patients is very few. Here in our case series, we diagnosed and treated such patients who had rare causes of pain abdomen- which included neuroendocrine tumors- gastric and duodenal, and mucinous cystic neoplasm of the pancreas.

Background - Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections (SSTIs) that cause necrosis of the muscle fascia and subcutaneous tissues. The infection typically travels along the fascial plane, which has a poor blood supply. Failure to obtain early diagnosis and delay in initiating appropriate treatment can lead to significant mortality and morbidity.

Case report –  Our patient was a23year old women, G4 A3 with 35 weeks+4 days of gestation with history of recurrent pregnancy loss came with complains of leaking per vagina since 6 hours. Patient was taken up for emergency Caesarean section as NST was non-reactive. On day 4, patient complained of pain at suture site and was febrile, hyperpigmentation was noted surrounding the suture site. Higher antibiotics were started and on day 5 wound was suggestive of necrotising fasciitis, patient was shifted to ICU and managed accordingly. This case report illustrates the challenging diagnosis and management of a case of necrotizing fasciitis.

Discussion - Necrotizing fasciitis following caesarean section is extremely rare with an incidence of 2 in 1000. Necrotizing fasciitis is rapidly spreading and is fatal if left untreated. High index of suspicion and early diagnosis, combined with surgical debridement and broad spectrum antibiotic therapy are required. Clinicians must quickly recognize the distinction between cellulitis manageable with antimicrobial therapy and Necrotizing Fasciitis requiring surgical intervention