Stump appendicitis.

Stump appendicitis is a rare and late complication following appendectomy and can often be overlooked. Our case details a 42-year-old male who presented to the Emergency Department with right-sided lower abdominal pain, nausea, and vomiting. A computed tomography scan of his abdomen and pelvis demonstrated a tubular, fluid-filled structure with surrounding inflammatory changes at the level of the patient\u27s appendectomy clips with a 2.3-cm calcified intraluminal stone. Findings were concerning for stump appendicitis with appendicolith. He was admitted and taken to the operating room for a laparoscopic stump appendectomy. Stump appendicitis should always be considered in the differential diagnosis to prevent potentially serious complications

Varicose Vein of Bilateral Lower Limb: A Review

Varicose veins are tortuous, winded veins in the subcutaneous tissues of legs. These veins are visible and can be easily diagnosed clinically. The varicose veins are usually incompetent and may result in the reflux of blood and ultimately venous hypertension. Varicose veins are usually found asymptomatic however it may result in local pain, heaviness in the limb, change in the color, itching, dryness and may develop ankle swelling including cramps. Conditions that increase pressure on leg veins such as obesity, sedentary life style, lack of activity or exercise, hormonal fluctuations during pregnancy, menopause, smoking, heavy weight lifting may lead to varicose veins. Keywords: - Varicose, Reflux, Vein, Incompetent

Efficacy of Hijamah Bila Shart (Dry Cupping) in Primary Dysmenorrhea

Usre Tams (Dysmenorrhea) is the most common of gynecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population.  Since ancient times, Hijamah bila Shart (Dry cupping) is a method of treatment for this disease. Therefore, objective of this preliminary study was to evaluate the efficacy of Hijamah bila Shart on intensity of pain in Usre Tams by using verbal multi-dimensional scoring system. It was conducted on 40 patients. Patients suffering from primary dysmenorrhoea with regular cycles, age group 15-40years were selected. For dry cupping, two glass cup of medium size were applied below the umbilicus for 20 minutes on day land/or day 2 of the menstrual phase for one cycle and pain intensity was assessed by verbal multi-dimensional scoring system for pain before and after the treatment. Keywords: Dysmenorrhoea, Hijamah bila Shart, Dry cupping, Usre Tam

EFFECT OF MURMUKI (Cammiphora myrrh) WITH BOILED EGG IN LEUCORRHOEA (Sailan-ur- Reham): A SINGLE CASE STUDY

Leucorrhoea is a universal problem of women. Nobody usually escapes from this illness. It is a very common condition that has been faced by most women of all ages particularly in reproductive period. It is symptom of underlying pelvic pathology. Sometimes this symptom is so severe that it over shadow actual disease and women seek the treatment for only this symptom. The white discharge is, however caused by the presence of infection in the genital tract and variety of other reasons. This was the case study of 29 year old female suffered from leucorrhoea treated with Murmuki (Cammiphora myrrh) along with boiled egg. Keywords: Leucorrhoea, Unani medicine, Murmuki, Sailan-ur- Reha

Current Immunotherapeutic Strategies in Malignant Melanoma.

The basis of immunotherapy for melanoma is the existence of melanoma-associated antigens that can be targeted by the immune system. Identification of many of these antigens has enabled investigators to develop a wide array of immunotherapy strategies for the treatment of melanoma. Although several of these strategies have been shown to induce antitumor immune responses in some patients, robust clinical responses have been observed less frequently. With exciting recent advancements in this field, however, there is promise of generating potent immunologic responses and translating them more consistently into durable clinical responses. This article reviews several current approaches to immunotherapy for melanoma and describes the key role that surgeons play in advancing this area of oncology

Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries

Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries. Methods: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in 112 953 pregnant women. We generated study-specific estimates and pooled subgroup estimates using fixed-effects models and assessed heterogeneity between subgroups with the χ2 test for heterogeneity. We did sensitivity analyses using random-effects models, stratifying by iron-folic acid dose, and exploring individual study effect. Findings: Multiple micronutrient supplements containing iron-folic acid provided significantly greater reductions in neonatal mortality for female neonates compared with male neonates than did iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75–0·96 vs 1·06, 0·95–1·17; p value for interaction 0·007). Multiple micronutrient supplements resulted in greater reductions in low birthweight (RR 0·81, 95% CI 0·74–0·89; p value for interaction 0·049), small-for-gestational-age births (0·92, 0·87–0·97; p=0·03), and 6-month mortality (0·71, 0·60–0·86; p=0·04) in anaemic pregnant women (haemoglobin <110g/L) as compared with non-anaemic pregnant women. Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI <18·5 kg/m2; RR 0·84, 95% CI 0·78–0·91; p=0·01). Initiation of multiple micronutrient supplements before 20 weeks gestation provided greater reductions in preterm birth (RR 0·89, 95% CI 0·85–0·93; p=0·03). Generally, the survival and birth outcome effects of multiple micronutrient supplementation were greater with high adherence (≥95%) to supplementation. Multiple micronutrient supplements did not significantly increase the risk of stillbirth or neonatal, 6-month, or infant mortality, neither overall or in any of the 26 examined subgroups. Interpretation: Antenatal multiple micronutrient supplements improved survival for female neonates and provided greater birth-outcome benefits for infants born to undernourished and anaemic pregnant women. Early initiation in pregnancy and high adherence to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex. Funding: None