ABSTRACT
Introduction: Thrombocytopenia is a common symptom of malaria, and typically occurs more frequently in Falciparam malaria. It appears that P. vivax does trigger thrombocytopenia, contrary to popular belief. Therefore, patients with low platelets and fever ought to be considered for malaria, though B12 deficiency does not always accompany malaria cases. Methods: This study was conducted at indoor patients at the NIMS hospital to investigate the relationship between vitamin B12 with thrombocytopenia associated with dengue fever and malaria. Patients were investigated for routine investigations such as CBC, ESR, RFT, RBS, LFT, PBF, VIT B12 LEVEL, Dengue profile and MP card test. In out of 125 patients,75 patients have dengue fever, and 50 patients have malaria fever. Result: In dengue fever out of 75 patients, 61 patients (81%) had thrombocytopenia with vitamin B12 deficiency (B12 level <100 pg/l). In malaria out of 50 patients, 28 patients (56%) have thrombocytopenia with vitamin B12 level (B12 level >300 pg/l), 22 patients (44%) have thrombocytopenia with vitamin B12 level normal (B12 level 201-300). Vitamin B12 level < 190 pg/ml was found in 47(94%) patients with severe thrombocytopenia while 32 number (74%) patients with mild thrombocytopenia. In group with B12<190 pg/ l need of SDP transfusion was significantly high i.e; (115.13±42.08) in comparison to other groups, as well as the recovery time of platelets to 20000/µl threshold, was found to be high in B12 <190 pg/l group (42.60±8.89 days) as compared to other groups. Conclusion: Using platelet analysis by PBF, the results of this study were obtained. There is no clumping of platelets, and the platelets show the normal size, color, and shape.

ABSTRACT
Autonomic nervous system abnormalities are major causes of morbidity and mortality in patients with chronic renal failure (CRF) on hemodialysis and are generally considered a part of polyneuropathy. Postural hypotension, impotency, gastrointestinal disturbance, gastrointestinal motility, and sweating abnormalities are common symptoms. The most frequent complication in patients with CRF on hemodialysis is intradialytic hypotension, and it has been suggested that intradialytic hypotension is mostly related to autonomic neuropathy. The pathogenesis of autonomic neuropathy is unclear, but a reduced response to norepinephrine by the end organ and the toxic effect of metabolic toxins are considered to be some of the causes. Five cardiovascular reflex tests are generally used to determine autonomic neuropathy: the heart rate reaction to the Valsalva Maneuver, the heart rate variability during deep breathing, the heart rate response to standing up, the blood pressure response to standing up, and the blood pressure response to hand grip exercise.

ABSTRACT
Introduction: Cardiovascular diseases are the leading cause of death globally and stroke is the second cause of death. To prevent the stroke, controlling risk factors is the best way. Disability is a death cause also. So, knowledge regarding the risk factors is very important for treating and preventing hemorrhagic stroke. Aim of the study: The aim of this current study was to evaluate the risk factors for hemorrhagic stroke. Materials and Methods: This study was a case-control study carried out at Dept. of Medicine, Sheikh Hasina Medical College Hospital, Tangail, Bangladesh from January to June 2021. A total number of 66 subjects of more than 18 years were considered for the study as the study subjects. Among them, 33 were in the study (Case) group and 33 were in the control group. The study population had been selected according to the pre-defined exclusion and inclusion criteria. Results: In analyzing the risk factors between the groups, it was found that there were 22 smokers in the study group and 18 in the control group. There were 11 non-smokers in the study group and 15 in the control group. The study shows that there were 29 non-diabetic patients in the study group and 28 in the control group. There were 4 diabetics in the study group and 5 in the control group. There was statistically no significant difference between study and control groups in smoker vs non-smoker and diabetics vs non-diabetics population. It was also found that there were 8 non-hypertensive patients in the study group and 29 in the control group. There were 25 hypertensive patients in the study group and 4 in the control group. There was a statistically significant difference between the study and control groups. There were statistically significant differences between the study and control groups regarding hypertension and total serum cholesterol. Conclusion: According to the findings of this study we can conclude that hypertension, as well as low total serum cholesterol, are potent

ABSTRACT
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is defined as excessive fat in the liver that is not caused by excessive alcohol consumption. Recent studies have shown that NAFLD can predict the onset of diabetes and vice versa, and that one ailment might act as a progression factor for the other. The paper aims to find out the various risk factors associated with developing Non-Alcoholic Fatty Liver Disease (NAFLD) in patients with type 2 Diabetes Mellitus to prevent both hepatic and systemic flares. Material and Method: A prospective cross-sectional observational study was conducted around 950 known patients of type 2 Diabetes Mellitus attending the outpatient Diabetes clinics during a period of May 2019 to May 2021 at NIMS Medical College & Hospital. Among them, 150 patients, willing to participate were selected as per inclusion and exclusion criteria. Results: A statistically significant difference was observed between the study groups in relation to Total Bilirubin, Direct Bilirubin, Indirect Bilirubin, serum proteins, Albumin, AST, ALT, Alkaline Phosphatase as the p-value calculated to be <0.05. Conclusions: The study showed people with high glycemic index have a higher chance of developing the disease. Thus tighter control of blood glucose level is the key to prevention. Obesity, uncontrolled diabetes, deranged lipid profile and abnormal liver enzymes are some of the risk factors for developing NAFLD. Thus screening must include all this risk factors and management strategies should address them separately.

ABSTRACT
The gastrointestinal tract (GI) is a continuous hollow twisting tube from the mouth to the anus. Its hollow organs include the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver, pancreas, and gallbladder (solid organs) are also considered part of the GI tract. The principal functions of the GI tract are digestion, absorption, excretion, and protection. Digestion and absorption occur primarily in the stomach and small intestine. Desiccation and compaction of waste occur in the large intestine. The waste products are then stored in the sigmoid colon and rectum before their elimination. The GI tract is influenced by several lifestyles, including the amount and the composition of the diet. The macronutrients and micronutrients in the diet, if prudent, are important for maintaining good GI health. However, unhealthy choices may cause or influence the development of GI pathology (such as esophageal reflux, peptic ulcer, inflammatory bowel disease, dietary intolerance, or even GI cancers). The lifestyle GI connection is reviewed in this two-part manuscript.

ABSTRACT
The gastrointestinal (GI) tract is responsible for ingestion of food and beverages, its propulsion, digestion, absorption, and finally excretion of its unabsorbed waste products. It is one continuous tube, measuring about 7-11 meters. Different sections have different structures, pH, and functions. Symptoms of a GI disease may differ according to the location and type of lesion. In the oral cavity, the patient may have trouble eating and swallowing. Esophageal reflux may cause heartburn, peptic ulcer disease and pancreatitis may cause stomach pain, while ailments of the intestines may cause malabsorption and diarrhea. GI ailments can greatly reduce the quality of life. They can also hasten mortality. The GI system is strongly affected by lifestyle factors, with unhealthy lifestyles increasing the risk and progression of various GI ailments. This manuscript looks at its relationship with four lifestyle factors, namely smoking, alcohol intake, exercise, and obesity. Its relationship with diet was discussed in part I of this two-part manuscript.

ABSTRACT
Background: Many studies have shown that high circulating uric acid (UA) levels lead to both hypertension and cardiovascular complications, leading to poor patient prognosis. People with metabolic syndrome (MetS), which is closely linked to hypertension, also tend to have high SUA levels. SUA levels elevate due to metS and hypertension share common pathophysiological features, so it has been difficult to confirm their involvement in the pathogenesis of hypertension. Therefore, the aim of this present study is to find out the association between the uric acid and blood pressure levels in both male and female patients of different age groups. Methods: It was 18 months, single-centered, cross-sectional study, conducted in the department of General Medicine, at National institute of medical sciences and research hospital. Blood samples were collected from 140 participants of both genders attending the department of Medicine with hypertensive and pre-hypertensive stages to analyze serum uric acid (SUA) level and lipid profile. The potential relationship between SUA and BP was assessed by descriptive statistics for analyzing quartiles and odd ratio. Results: Among 140 hypertensive patients, 66 of them were in the 61-80 age groups. Twenty percent of patients were under the age of 20 and one percent was over 87 years of age. 40 patients with pre-hypertension, 28 (70%) of patients having elevated SUA level, while 100 of patients with hypertension, 59(59%) of having elevated SUA level. It had also been found that the diagnosis duration of hypertension and hyperuricemia was causing the elevation of SUA levels in the patients. Conclusion: The present study indicates a direct relationship between SUA levels and hypertension. SUA levels were quite a bit higher in patients with hypertension in contrast to those with pre-hypertension, suggesting the severity of hypertension related to SUA levels.

ABSTRACT
Introduction: Chronic Obstructive Pulmonary Disease-induced chronic inflammation may cause or aggravate co-morbid conditions. Anaemia is a significant comorbidity. Aim of this study: This study aims to diagnose iron-deficiency anaemia in COPD patients and assess the benefits of iron supplementation. Material & Methods: This was an 18-month interventional trial undertaken in the general medicine department of a tertiary care teaching hospital. The systematic process was followed to get the institutional ethics committee's approval. Results: The study population averaged 51.32 years. Most patients (68%) were between 51 and 60 years old. Out of 150 individuals, 29% had anaemia, and 121% were non-anaemic. Conclusion: Anaemia and iron deficiency are significant comorbidities in patients with chronic obstructive pulmonary disease (COPD), according to the Indian Journal of Clinical Pharmacology and Biomarkers (JPCB) published in 2012.

ABSTRACT
Prolymphocyte leukemia is a very rare, complex, and often aggressive, mature lymphoid hemopathy. The mean age of onset is 65 years with a predominance of males. We report here the case of a patient with splenomegaly and severe lymphocytosis in whom the smear showed an invasion of 90% of prolymphocytes suggesting Prolymphocyte leukemia confirmed by immunophenotyping. Both purine analogues and monoclonal antibodies have shown promoting results, however, allogeneic hematopoietic stem cell transplantation remains the only therapeutic means allowing a lasting response. However, it is reserved for young patients with compatible donors. A good understanding of the pathogenesis and a better integration of the molecular data of this hemopathy open the way to the use of new targeted therapies.