ABSTRACT
Purple urine bag syndrome (PUBS) is a rare clinical condition in elderly constipated females on long term urinary catheters. By-products of dietary tryptophan metabolism are implicated in its pathogenesis. Bacteria in large intestine deaminate tryptophan to indole which is detoxificated in liver to indoxyl sulphate and excreted in urine. Uropathogens colonizing the catheter bags and tubes convert indoxyl sulphate to indigo (blue pigment) and indirubin (red pigment) under aerobic and anaerobic conditions respectively. The reaction between the above urinary pigments and polyvinyl chloride (PVC) is essential for the characteristic purple discoloration in urine. Asymptomatic patients are treated with regular catheter change and laxatives for constipation. Patients with symptomatic urinary tract infection, urosepsis, immunosuppression and persistent PUBS need antibiotics. Here we report PUBS in a patient with neurogenic bladder.

ABSTRACT
Background: Using brachial plexus blocks as regional anaesthetic is standard procedure for upper limb surgery. Although a retro-clavicular brachial plexus block has just been proposed, another technique has not been thoroughly evaluated. This single-blinded, randomized, controlled experiment looked at whether the retroclavicular technique had a higher success rate than the supraclavicular approach. Methods: This experimental study was conducted in the Department of Anaesthesia, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh From June 2019 to June 2021. The physical state of one hundred and twenty ASA members there was randomization of 1-3 patients having distal surgery on their upper limbs to receive a 30 mL 1:1 mixture of mepivacaine and ropivacaine, which was administered as a single injection without repositioning the needle tip, using ultrasound guidance for the retroclavicular or supraclavicular brachial plexus block. In the 30 minutes following local anaesthetic injection, the primary outcome was block success rate defined as a composite score of 14 points, including sensory and motor components, inclusive. Additionally, secondary outcomes were the number of needles used, the time it took to obtain an opioid, the amount of oxycodone taken, and the patient's postoperative pain level (on a numeric rating range of 0-10). Results: Success rates were 98.3% [95% confidence interval (CI): 90.8%, 99.9%] and 98.3% [95% CI: 90.9%, 99.9%] in the supraclavicular and retroclavicular groups, respectively (P¼0.99). The mean needling time was reduced in the supra- clavicular group [supraclavicular: 5.0 (95% CI: 4.7, 5.4) min; retroclavicular: 6.0 (95% CI: 5.4, 6.6) min; P¼0.006]. The mean time to first opioid request was similar between groups [supraclavicular: 439 (95% CI: 399, 479) min; retroclavicular: 447 (95% CI: 397, 498) min; P¼0.19] as were oxycodone consumption [supraclavicular: 10.0 (95% CI: 6.5, 13.5 mg; ...............

ABSTRACT
Introduction: Earlier studies from the developing countries as well as from other terrains of Bangladesh showed various aetiologies of head injuries. However, there is no substantiative government data’s are available regarding the cause and manner of head injury. Objective: The current study was conducted with an objective to determine the aetiological pattern of head injury in the region. Materials & Methods: The study was conducted in Dept. of forensic medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from June-2019 to July-2021. Cases of fatal head injuries irrespective of their aetiology that were brought for medicolegal autopsies over a period of two years were included in this study. The data with regard to their age, sex, mode of injury in detail was collected and interpreted. Results: Out of total 59 cases of fatal head injury who succumbs to death, 90% were males. Maximum numbers of cases (27.11%) were in age group of 21-30 followed by 31-40 year (22.03%). Roadside accident was the leading cause of head injury (65%) while only 15% were as a result of assault. Two wheeler riders comprises of 35.31% followed by pedestrians (24.3%). Maximum number of fatalities due to head injury was due to roadside accident and that too in a productive age group of 21- 40 years. Rider two wheelers and pedestrian were involved in majority. Conclusion: To minimize the morbidity and mortality resulting from head injury consequent to road accidents there is a need for better maintenance of roads, strict enforcement of traffic rules, compulsory wearing of crash helmets by two wheelers along with imparting of compulsory road safety education to school children from primary education level.

ABSTRACT
Introduction: The surgeon considers abdomen as an enigma because in a good proportion of his cases, the cause of abdominal pain or the nature of the abdominal lump, may not be decided in spite of all possible investigations. But application of anatomical knowledge makes diagnosis more interesting and more rational except in few cases. Objective: To assess the diseases in patients with Non-Traumatic Acute Abdomen. Materials and Methods: It is a prospective study. Two hundred cases of nontraumatic emergency laparotomy patients were studied in Different surgical units of Dhaka Medical College Hospital during the period of July 2007to June 2008. The peak age incidence was found in the third decade of life (34%). Overall male-female ratio was 2.3:1, but there were disease specific variations. Acute abdominal pain was the constant symptom with different degree of severity, presenting either locally or diffusely. In conditions with peritonitis either local or diffuse, muscle guarding, rigidity or diminished bowel sound were found. Results: In the present study 200 patients were included. All these patients underwent emergency laparotomy with the provisional diagnosis of acute abdomen. Conclusion: The most common cause of acute abdomen in the study was acute appendicitis, affecting young population; this was followed by Hollow viscus perforation with peritonitis and bowel obstruction. To evaluating patients with acute appendicitis and peritonitis, plain x ray abdomen high sensitive in bowel obstruction and peritonitis as well. USG abdomen had high specificity as well as positive and negative predictive value in acute appendicitis. Acute appendicitis was the commonest cause 48% of patients presenting to Emergency and Casualty as acute abdomen. It must be remembered that 'Diagnostic errors at the initial assessment may at best result in unnecessary surgical intervention, and at worst demise of the patient or a protracted illness due to the development of complications, ......

ABSTRACT
Many different viruses infect the respiratory tract. In children, rhinoviruses, influenza viruses (during annual winter epidemics), parainfluenza viruses, respiratory syncytial virus (RSV), enteroviruses, coronaviruses, and certain strains of adenovirus are the main causes of viral respiratory infections. Most often, viral respiratory tract infections spread when children's hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the children touch their nose or eyes, the viruses gain entry and produce a new infection. Less often, infections spread when children breathe air containing droplets that were coughed or sneezed out by an infected person.

ABSTRACT
Cataracts are a common eye disease and one of the leading causes of blindness worldwide. In patients with cataracts, the eye lens hardens and becomes cloudy, which results in vision deteriorates over time, making it difficult for the patient to carry out routine activities. There are many factors for the occurrence of the disease, the most common factor is aging. There is no treatment to prevent or stop the progression of cataract; however, the only treatment is to undergo surgery, where original lens is replaced by a new artificial lens, that can enable the patient to see clearly.

ABSTRACT
A technique based just on the Denis Browne principle of the buried skin strip is presented and considered the treatment of choice for the vast majority of cases of Hypospadias. No perineal drainage or beads and collars are used, but instead 3 layers of resorbable 5/0 sutures on atraumatic cutting edge needles are used. Also variations of the basic principle are described as all techniques have to be adapted to the individual Patient A place must always exist for the knowledge and possible use of other techniques, if they seem to fit better a particular case.

ABSTRACT
Objectives: Correct the phimosis but preserving the prepuce. Methods: using the mesh graft plastic surgical principle often used in extensive 3rd degree burns. Results: Excellent aesthetic and functional results. Conclusion: the method of choice if one wants to correct the phimosis but preserve the prepuce.

ABSTRACT
It is described as an original technique developed hoping to correct an extremely rare penile anomaly of “mega-urethra and hypospadias” appearing in the context of a “Triad Syndrome” anomaly. A progressive folding of the penile shaft together with partial excision of penile skin and correction of the hypospadias with tubularization of the urethral mucosa and obtaining a quite satisfactory end result (both aesthetic and functional).

ABSTRACT
Rectal injuries due to blunt or penetrating trauma are associated with significant morbidity and mortality, yet there is a lack of consensus regarding their optimal management. The management of penetrating rectal trauma invokes a complex decision tree that has been established based on lessons learned during war. It involves proximal faecal diversion by a stoma, rectal washout and placement of pre-sacral drain. Today surgeons worldwide variably use these techniques. We present a case where a young male accidentally slipped and fell on a beer bottle which got inserted in his rectum. He presented a few days later with scrotal and perineal cellulitis.