ABSTRACT
Background: Epiploic appendagitis is a rare cause of acute abdominal pain due to ischemia or inflammation of the epiploic appendages, small fat filled structures along the colon. Because of its clinical presentation often mimicking more common conditions such as appendicitis or diverticulitis, it can be a diagnostic challenge. The appendix is equally uncommon in a subhepatic location, and this atypical location adds further to the diagnostic difficulty. Early recognition and treatment are important to prevent complications and to ensure effective treatment. Case Presentation: A non-hypertensive, non-diabetic male presented with a 3-day history of continuous right upper quadrant pain, accompanied by nausea and vomiting. Physical examination revealed right upper quadrant tenderness with rebound tenderness, while laboratory tests showed elevated inflammatory markers. Ultrasound findings included a non-compressible, edematous blind loop in the subhepatic region measuring 9.2 mm in diameter. It is surrounded by stranded mesenteric fat, echogenic mesocolic fat, colonic wall edema, and a minimal free fluid collection. Based on these findings, subhepatic acute appendicitis with associated acute epiploic appendagitis was diagnosed. The patient underwent emergency laparoscopic appendectomy and removal of the inflamed epiploic appendages. Intraoperative findings confirmed a suppurative appendix in the subhepatic region and thickened epiploic appendages surrounded by inflamed tissue. Histopathological analysis corroborated features of subhepatic appendicitis and epiploic appendagitis. Conclusion: The diagnostic and surgical complexities of subhepatic appendicitis and epiploic appendagitis are illustrated in this case. Laparoscopic surgery remains a safe and effective treatment and imaging is important in identifying atypical presentations. Management of atypical acute abdominal pain presentations requires awareness of these conditions.

ABSTRACT
Background: Cerumen is a natural substance secreted by sebaceous and ceruminous glands in the outer third of the external auditory canal (EAC). It serves by preventing infections, moisturizing the ear canal, and acting as a barrier against insects and water. Impacted cerumen affects approximately 6% of the general population, 10% of children, and over 30% of the elderly. Symptoms of impacted cerumen include tinnitus and hearing loss. In children, it can hinder language and speech development, while in adults, it can lead to depression, embarrassment, career limitations, and occupational stress. Treatment methods for impacted cerumen include the use of cerumenolytics (e.g., 3% hydrogen peroxide), syringing, manual removal, and microsuction under microscopic guidance. Objectives: This study intends to determine the prevalence of impacted cerumen in patients attending the ENT department, describe the management modalities of impacted cerumen and determine the outcomes of management of impacted cerumen. Methodology: A cross-sectional, hospital-based study was conducted for six months from December 2022 to May 2023. All patients attending Ear nose and Throat (ENT) clinic were included. Participants with impacted cerumen were consented and assessed using a structured questionnaire, followed by audiological examination with pure tone audiometry. Management outcomes were recorded immediately and on seventh day post-treatment. Data were analyzed using SPSS version 25.0, and audiometric data compared using an unpaired sample t-test. Results: The study included 1,717 participants, of whom 161 had impacted cerumen, with median age of 19 years (IQR: 12-28 years). Those over 50 years old were 85, (52.8%), and 82 (50.9%) were males. The prevalence was 9.4%. Treatment methods included microsuction 53.4%, manual removal under microscopic guidance 11.2%, and a combination of microsuction and cerumenolytics 35.4%. There was a significant improvement in symptoms following cerumen ...

ABSTRACT
Background: Tuberculosis remains a significant global health concern, with increasing incidence of drug-resistant strains posing challenges to effective treatment. We present a case of rifampicin-resistant tuberculous meningitis in an immunocompetent child, highlighting the severity and complexity of tuberculosis in pediatric populations. Case report: An 11-year-old child with a family history of tuberculosis was hospitalized for febrile meningeal syndrome. Symptoms included progressively developing headaches, vomiting, food refusal, and right hemiparesis over 10 days. Upon admission, the patient was conscious with a fever of 38.2°C and a stiff neck. Biological analyses revealed neutrophil-predominant hyperleukocytosis, lymphopenia, and hyponatremia. Cerebrospinal fluid analysis showed a predominance of lymphocytes and hypoglycorrhachia. The Xpert MTB/RIF ultra test confirmed tuberculous meningitis with detection of the rifampicin resistance gene. Imaging revealed active hydrocephalus. Second-line treatment was initiated, involving multiple medications over 24 months. This observation underscores the complexity of tuberculous meningitis in children, necessitating an individualized therapeutic approach. Conclusion: Drug-resistant tuberculous meningitis in children represents a complex and devastating medical challenge. Progress in diagnosis, while significant, underlines the need for a nuanced approach and ongoing research to improve screening tools.

ABSTRACT
Background: The three most prevalent mental health issues in Bangladesh are stress, anxiety, and depression. Another mental health disorder that maintains the capability to disrupt normal functioning of an individual is called ‘Social Anxiety disorder’ (SAD). Symptoms of social anxiety disorder (SAD) can reduce output, raise absenteeism, and impair job satisfaction. Employees with mental health disorders may find it difficult to focus, fulfill deadlines, or work well with others. Objective: To observe the social anxiety disorder (SAD) and its association with employment rate and workforce settings. Materials and Methods: A cross-sectional study was done to assess social anxiety among employees. The study was carried out from January 2021 to December 2022 at various formal employments in Dhaka city for people over the age of 18, both male and female, who had been working for more than one year. Workers receiving treatment for mental health issues were excluded from the study. The anticipated final sample size was 120 people divided into two groups: 60 people with Social Anxiety Disorder and 60 people who did not have it. This study employed a convenient sampling strategy. Participants who agreed to participate and met the selection criteria were chosen as a sample. Results: In the group of individuals with social anxiety disorder, 49 (81.7%) were employed, while 57 (95.0%) were not. Conclusion: The study reveals a strong link between social anxiety disorder (SAD) and lower employment rates, with individuals with SAD facing higher unemployment.

ABSTRACT
Introduction: Pulmonary tuberculosis remains a major global health concern, particularly in resource-limited settings like Nigeria. Oxidative stress has been implicated in the pathogenesis and complications of various diseases, including infectious diseases such as Tuberculosis. This study explored the impact of Pulmonary Tuberculosis infection on the antioxidant mechanisms and the resulting redox imbalance in general. The specific objective was to determine the changes in oxidative stress marker/antioxidant level by comparing the serum levels of Glutathione peroxidase, Vitamin C, Vitamin E and Malondialdehyde between PTB patients and control group. Method: A comparative cross-sectional study was conducted involving 214 pulmonary tuberculosis patients and 214 control group at AKTH. Blood samples was collected from both groups for the measurement of Malondialdehyde, Glutathione peroxidase, vitamins C and E. Clinical and demographic data was obtained through structured questionnaires. Results were presented as mean and standard deviation. Mean serum levels were compared using T-test while Mann Whitney u-rank test was used to determine correlation between Malondialdehyde and antioxidants. Results: Both PTB patients and the control group were largely composed of individuals between the ages of 21 and 40 years with a mean age of 34 years and 31 years respectively. The investigation demonstrated that individuals with PTB exhibited a notably higher Malondialdehyde level (1201+323µmol/L, p<0.05), in comparison to the control group (433+313µmol/L). Additionally, the average serum concentrations of Glutathione peroxidase, Vitamin C, and Vitamin E were significantly lower in the PTB patients (glutathione peroxidase: 218.4 ± 166.6 ng/ml, Vitamin C: 6.4 ± 2.5 µg/mL, and Vitamin E: 8.1 ± 1.6 µg/mL) compared to the control group (glutathione peroxidase: 653.2 ± 368.6 ng/ml, Vitamin C: 8.3 ± 3.8 µg/mL, and Vitamin E: 12.7 ± 2.2 µg/mL). Moreover, all three antioxidants level ...

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Background: The rising incidence of resistant fungal infections poses significant therapeutic challenges. This study aimed to compare the efficacy and safety of terbinafine monotherapy versus combination therapy with terbinafine and voriconazole in patients with resistant fungal infections. Methods: A total of 90 participants were enrolled from June 2022 to May 2024 at Colonel Maleque Medical College, Manikgonj, Bangladesh. Participants were randomly assigned to receive either terbinafine (6 mg/kg, maximum 500 mg/day) alone or in combination with voriconazole (200 mg/day). Outcomes assessed included mycological cure rates, clinical improvement, relapse rates, and adverse events over a 1-year follow-up period. Results: At 6 weeks, the mycological cure rate was 44% for the monotherapy group versus 78% for the combination group (p=0.001). At 1 year, the rates were 29% and 67%, respectively (p=0.001). Complete clinical improvement was observed in 29% of monotherapy patients compared to 62% in the combination group (p=0.002). Adverse events were more common in the combination group (44% vs. 22%, p=0.03), including higher rates of liver enzyme elevation and visual disturbances. Relapse rates at 1 year were lower in the combination group (27% vs. 44%, p=0.05). Conclusion: Combination therapy with terbinafine and voriconazole significantly improves mycological cure rates and clinical outcomes in resistant fungal infections compared to monotherapy, despite an increased incidence of adverse events.

ABSTRACT
Background: The pattern of child illness speacially neonatal illness varies depending on the location and period. examining the trend of newborn admissions. Being a low- and middle-income nation (LMIC), Bangladesh, understanding hospital admission patterns and post-care outcomes is crucial for a child's survival. In addition, Bangladesh has difficulty keeping up with and achieving the Sustainable Development Goal (SDG) in terms of newborn deaths and child mortality. Objective: This study's goal was to learn more about hospitalised patients' admission trends and treatment outcomes. Methods and Materials: The present retrospective study was carried out within the Department of Pediatrics at Prime Medical College Hospital in Rangpur, Bangladesh, spanning from January 2016 to November 2016. This study included a cohort of 1053 who were admitted at Prime Medical College Hospital. The cohort consisted of both inborn and outborn neonates throughout the specified period. Results: The most prevalent complications observed were perinatal asphyxia with hypoxic-ischemic encephalopathy (HIE) accounting for 24.8% (n=109), preterm low-birth-weight newborns comprising 34.2% (n=150), and neonatal septicemia representing 16.6% (n=73). The prevalence rates of Meconium Aspiration Syndrome and Neonatal Jaundice were found to be 3.4% and 5.7%, respectively. The leading cause of death were perinatal asphyxia accompanied with hypoxic-ischemic encephalopathy 19, which accounts for 50% of the total death, followed by preterm low birth 39.5%.The causes children admission in the hospital and highest cause of the admission is Respiratory system 30% (n=614) and Gastrointestinal (GI) tract 22.5% (n=614) and major cause of the child death 41.7% (n=12) and Nutritional disorder 25%. Though 97% of the patients have shown improvement in their health conditions and were subsequently discharged, while 1.95% unfortunately succumbed to mortality. Conclusion: The leading causes of neonatal ....