An Enigmatic Color Change of Urine: Alkaptonuria: Alkaptonuria

Alkaptonuria is an exceedingly rare tyrosine metabolism disorder of autosomal recessiveinheritance. Only a few instances of it have been observed in Bangladeshi children. Here,we talk about a 2-year-old boy who had dark urine and was later found to have alkaptonuria

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Effect of Acne Vulgaris and its Impact on Quality of Life of Adolescents in Bengaluru

Background and Objective: Acne vulgaris is a chronic condition affecting more than 85% of adolescents and young adults. This study was conducted to assess the prevalence of acne vulgaris and its impact on quality of life (QoL) and to study socio-demographic factors, family history and lifestyle among the selected schools at Jalahalli area in Bengaluru. Materials and Methods: This study was a descriptive cross sectional school based study and 200 subjects were included. Predesigned, questionnaire to assess socio-demographic profile and QoL and symptoms of acne vulgaris were administered to the participants fulfilling inclusion criteria. Data were obtained by using different methods such as Global Acne Grading System (GAGS), Cardiff Acne Disability Index and Children’s Dermatology Life Quality Index/Dermatology Life Quality Index (CDLQI/DLQI) respectively. SPSS 18.0 software was used for data analysis. Results: Findings showed that Acne prevalence was 87% affecting both sexes. Self-reported mild acne was present in 85.1% and moderate severe acne in 14.9% of the adolescents. The mean age of the subjects was 14.78 years, with 52.5% females and 47.5% males. A strong relation was found between the severity of acne and QoL (p<0.001). Heredity was correlated with acne and its severity was significant. Conclusion: Acne affects the QoL of an adolescent, and the impact is proportional to the severity of acne. Severe acne is associated with a greater effect on QoL. Evaluation of QoL in such patients may greatly help in the better management of acne, hence improving their quality of life. Keywords: Acne vulgaris; Adolescent; Quality of life; GAGS; CDLQI; DLQI

PBPK modelling of ceftriaxone Na-loaded starch-sodium alginate polymeric blend prepared by water-in-oil emulsification for oral delivery

Ceftriaxone is a third-generation cephalosporin antibiotic effective against many bacterial infections. However, owing to its instability in the gastrointestinal tract (GIT), it is administered by injections, which is an unfavourable route of administration. Therefore, the aim of this study was to formulate ceftriaxone into biodegradable and thermally stable polymeric blend microparticles that are suitable for oral delivery. The drug-loaded microparticles were prepared by the water-in-oil (W/O) emulsion method and consisted of starch and sodium alginate (NaAlg) as a polymeric matrix and glutaraldehyde (GA) as a cross-linking agent. Characterization of these particles using scanning electron microscopy (SEM) showed that the particles were spherical in shape with a smooth surface. Differential scanning calorimetry (DSC) and X-ray diffraction (XRD) of these particles showed no drug-polymer interactions. The highest percentage yield of particles was obtained at 3% polymer concentration. The particle size increased slightly after drug loading. The drug loading and entrapment efficiency appeared to increase with increasing polymer concentration. In vitro drug release at pH 1.2 and pH 7.4, revealed that drug release was below 20% at the acidic pH, while at pH 7.4, drug release of up to 85% was observed. The release mechanism followed first-order and Fickian diffusion patterns. Plasma concentration-time profiles were simulated for subcontinental Asian populations using commercial PBPK software, and the results suggest that microencapsulation of ceftriaxone sodium in a polymeric blend could represent a promising approach for controlled oral delivery of the drug, with enhanced absorption and bioavailability of the drug

Cutaneous Malignancy due to Arsenicosis in Bangladesh: 12-Year Study in Tertiary Level Hospital

Bangladesh is grappling with the largest mass poisoning of a population in the world due to contamination of drinking water with naturally occurring inorganic arsenic. It is estimated that 75 million people of 59 (out of 64) districts are at risk of drinking contaminated water with arsenic above 50μg/L. Long term exposure to arsenic causes cancers, including skin, lung, and bladder. This is a randomized prospective study to see the prevalence of skin cancer from arsenic affected area of Bangladesh, as well as their variation by geographical area, age, gender, location on the body, and socioeconomic conditions, in outpatient department of plastic surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU). A total of 960 patients with skin cancers comprised of 528 males and 432 females were selected for the study from January 2004 to December 2015. In this 12-year study, we found squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma to be associated with the ingestion of arsenic contaminated ground water. This is a reflection of a small part of the total national scenario of devastating result of arsenic mediated cancer in terms of skin malignancy. This study will help the future researchers who are contemplating to work on arsenic induced health problem

<i>Enterobius vermicularis</i> Related Acute Appendicitis: A Case Report and Review of the Literature

While the debate on the association between Enterobius vermicularis (E. vermicularis) and acute appendicitis has not been settled, a few case reports of this very rare encounter are beginning to come to light. E. vermicularis is one of the most common parasitic infections around the world, and acute appendicitis, on the other hand, is also a commonly encountered condition in general surgery. However, the association between these two conditions remains controversial. Here we present a case report of a young woman with appendicitis associated with E. vermicularis

Initial experience of a second generation self expanding transcatheter aortic valve. The Uk & Ireland Evolut R Implanters' Registry

ABSTRACT Objectives This study presents the United Kingdom and Ireland real-world learning curve experience of the EvolutTM R (Medtronic, Minneapolis, Minnesota, USA) transcatheter heart valve. Background The EvolutTM R is a self-expanding, repositionable and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcome, and reduce complications. Methods Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive an Evolut RTM valve in the United Kingdom and Ireland. Results 264 consecutive EvolutTM R implants were performed across 9 centers. Mean age was 81.1 ± 7.8 years and mean Logistic EuroScore was 19.9 ± 13.7%. Procedural indications included aortic stenosis (72.0%), mixed aortic valve disease (17.4%) and failing aortic valve bioprostheses (10.6%). Conscious sedation was used in 39.8% of cases and transfemoral access in 93.6%. The procedural success rate was 91.3%, and paravalvular leak immediately after implantation was mild or less in 92.3%. Major complications were rare: cardiac tamponade 0.4%; conversion to sternotomy 0.8%; annular rupture 0.0%; coronary occlusion 0.8%; major vascular 5.3%; acute kidney injury 6.1%; new permanent pacemaker implantation 14.7%; and procedural-related death 0.0%. At 30-day follow-up survival was 97.7%, paravalvular leak was mild or less in 92.3% and stroke rate was 3.8%. Conclusions This registry represents the largest published real-world experience of the EvolutTM R valve. Procedural success rate was high and safety was excellent, comparable to previous studies of the EvolutTM R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices