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Primary myelofibrosis (PMF) is a distinct clinicopathological myeloproliferatve disease (MPD) not preceded by any other MPD ET, PV, CML,... Combined use of bone marrow histology and increased erythrocyte counts above 5.8x1012/L can replace increased red cell mass at time of presentation as the pathognomonic clue for the correct diagnosis of hetero/homozygous or homozygous mutated PV. Erythrocyte counts are in the normal range below 5.8x1012/L in heterozygous JAK2V617F mutated ET and prodromal PV but above 5.8x1012/L in heterozygous-homozygous or homozygous mutated PV. The bone marrow cellularity and morphology in pre-fibrotic ET, prodromal PV and PV carrying the JAK2V617F mutation are overlapping showing clustered increase of large mature pleomorphic megakaryocytes (M) with no increase of cellularity (<60%) in ET. The bone marrow is hypercellular (60%-80%) due to increased erythropoiesis megakaryopoiesis (EM) in prodromal and classical PV and trilinear hypercellular (80%-100% due increased megakaryopoiesis, erythropoiesis and granulopoiesis (EMG) in advanced PV and masked PV. Bone marrow cellularity ranging from normal (<60%) in ET to increased erythropoiesis (EM) in prodromal PV to hypercellular (80-100%) in advanced PV and masked PV largely depends on increasing JAK2V617F mutation load from low to high on top of other biological MPN variables like constitutional symptoms during long-term follow-up. MPL515 mutated ET is featured by an increase of clustered small and giant megakaryocytes with hyper-lobulated staghorn-like nuclei in a normal cellular bone marrow. The third entity of pronounced JAK2/MPL wild type ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) without PV features proved to be caused by calreticulin (CALR) mutation. CALR mutated thrombocythemia is characterized by dual proliferation of megakaryocytic and granulocytic bone marrow proliferation of dense clustered large to giant immature dysmorphic megakaryocytes with bulky (bulbous) hyperchromatic nuclei, which are not seen in MPL515-mutated Thrombocythemia and JAK2V617F-Thrombocythemia, prodromal PV and classical PV. 

Antibiotic resistance is a growing global crisis, straining healthcare systems and leaving us with limited options to combat drug-resistant bacteria. This retrospective, cross-sectional study examines the prevalence of antibiotic resistance patterns among urinary tract infections (UTIs) in Al-Shifa Hospital’s medical departments in comparison with non-medical departments using data from microbiology laboratory archives over a one-year period. From the examined urine cultures about 25% were obtained from internal medicine departments and double the number was obtained from non-medical departments. The positive rate was around 35% and about two-thirds of the samples were collected from female patients. Among all departments, Enterobacteriaceae spp. were found to be the most frequently isolated uropathogens, accounting for 80% of cases. However, resistance rates varied depending on the specific organism and antibiotic used. For instance, E. coli showed a resistance rate of only 5% against meropenem, while amoxicillin-clavulanic acid exhibited a resistance rate exceeding 95%.Importantly, the study revealed a significant disparity in resistance rates between medical and non-medical departments, specifically concerning third-generation cephalosporins. In internal medicine departments, resistance rates were alarmingly high, with cefotaxime, ceftriaxone, and ceftazidime showing resistance rates of 75%, 75% and 66.5% respectively. In contrast, non-medical departments displayed lower resistance rates, approximately 60%, 60% and 40%, respectively.In summary, this research sheds light on the escalating problem of antibiotic resistance in UTIs and emphasizes the discrepancy in resistance rates between medical and non-medical departments. Urgent efforts are required to address this issue and find effective solutions to prevent the rise of untreatable bacterial infections.

Cotton crop is infested with different kinds of insects in the production cycle. Jassids, thrips, aphids and whiteflies are among the sucking pests, and bollworms (American and spotted) and Spodoptera caterpillars attack leaves and bolls. Bollworms can cause up to 40% - 50% crop losses in severe incidences.

Introduction: Thalassemia is an inherited blood disorder of haemoglobin (Hb) synthesis, which affects different regions around the world. India has the largest number of children with beta-thalassemia major in the world, particularly in the tribal population. Heterozygous conditions are milder and even go unreported than the condition of homozygous where regular blood transfusion is required.Case report: This report focuses on a case of major beta-thalassemia in a child, whose parents are beta thalassemia minor to intermediate conditions, and who was treated by blood transfusion once a month. However, Thalassemia may be cured by allogeneic hematopoietic stem cell transplantation, although not everyone is a good candidate. Genetic counselling, prenatal diagnosis, and selective termination of affected fetuses are effective ways to control thalassemia.Discussion and conclusion: The paper reports a unique case of Thalassemia in rural India. The blood disorder while commonly presented in a juvenile whose parents were Thalassemia positive resulted in the termination of a fetus diagnosed with it. It archives the story of the parents who are now in the process of planning future offspring while mitigating disease risk. The case leads the way for effective management and containment of hereditary genetic disorders through carrier detection while planning alliances and offspring.

Sarcoidosis is a multisystem disease of unknown origin that is characterized by non-caseating epithelioid granuloma formation within various organs, mainly the lungs [1]. The objective of this study is the analysis of sarcoidosis patients affected by pulmonary manifestation alone or extrapulmonary expression.

An article by Baum, et al. “Unclear swelling in the region of a maxillary canine tooth” [1] caught our interest. A 14-year-old boy had developed an adenomatoid odontogenic tumor (AOT) without undergoing maxillofacial surgery. During an INTERPLAST-Germany mission [2] in Goma, Democratic Republic of Congo, we operated on a young man with an advanced odontogenic tumor. Since we are confronted with fist-sized odontogenic tumors (mostly ameloblastoma of the mandible) every time we operate in Africa, where they grow out of control due to a lack of experienced surgeons, it may be of interest to our colleagues in developed countries to know which grotesque tumors are prevented by early surgery.

Case report: This case report aimed to evaluate temporomandibular joint activity in a patient with the temporomandibular disorder before and after disclusion time reduction (DTR) therapy.Results: Positive changes in joint health were observed in the patient after the DTR treatment. Conclusion: The joint vibration analysis objectively showed significant results with the disclusion-time reduction therapy. The measured parameters were closer to the reference values. Thus, DTR is an effective method to treat TMJ disorders, based on Piper’s classification.

Considering the geographical complexity and adversity, online communication and consultation are viable method in Nepal. The COVID-19 pandemic has accelerated the already starting trend of use of these technologies in medicine. In BPKIHS, telemedicine efforts were already initiated; lockdown rather warranted its maximum use. Here is an account of the observation made in telepsychiatry service provided by a consultant psychiatrist of its department of psychiatry. It is an institute-based observation noted for all the telepsychiatry consultations in 9 random duty days of the COVID-19 pandemic. Basic necessary information was noted down in a semi-structured proforma, like: socio-demographic, clinical information and advice provided. There were 104 subjects; 73 follow-up and 31 new: 60 male and 44 female cases. Clients of multi-ethnic groups were the most from urban, then semi-urban and least from rural areas. More consultations were for young age-groups and from nearby districts of Sunsari. Mood, somatic (sleep), anxiety were the top presenting complaints and 8/104 clients had suicidal symptoms. Maximum follow-up cases were improving. The most common diagnoses were: Mood (Depression and Bipolar), Anxiety, Psychosis and Substance use disorders. Most common treatment advices included: Antidepressants, Antipsychotics, Benzodiazepines and Counseling/psycho-education. Telepsychiatry is a viable method of delivering service even during the pandemic. 

Spindle cell lipoma and pleomorphic lipoma emerge as benign, adipocytic neoplasms representing a morphologic continuum of a singular neoplasm. In addition to myofibroblastoma and cellular angiofibroma, spindle cell lipoma or pleomorphic lipoma configures as a constituent of chromosome 13q/RB1 family of tumors. Initially scripted by Enzinger and Harvey in 1975 with an obsolete terminology of dendritic fibromyxolipoma, aforesaid adipocytic neoplasms articulate an estimated 1.5% of lipomatous tumors. In contrast to conventional lipoma, spindle cell lipoma or pleomorphic lipoma is an uncommonly discerned variant, demonstrating a proportion of 1: 60.

Methods: Experimental phase: Performed a partial nephrectomy off clamp in pig model followed by cauterization of lidocaine gel 2% with different power (control, 30W, 50W and 100W) in the kidney resection bed to evaluate efficacy and deep injury extension. Clinical phase: 20 patients submitted to laparoscopic or partial nephrectomy for low risk RENAL score were utilized greased lidocaine gel 2% with 50W in cautery scalpel to hemostasis of renal parenchima to validate efficacy and safety. Results: Experimental study shows that this technique is effective and promote better hemostasis with 50W and 100W, with deep injury of less than 3 mm. Clinical study confirm efficacy, good control of hemorrage, few complications and no transfusion. Minimal changes in hematocrit, haemoglobin and creatinine were observed. Conclusion: In this preliminary experience the use of this new alternative to hemostasis for low risk partial nephrectomy was satisfactory and with good intra and postoperative results. The best advantages were safety in terms of the depth thermal injury, low cost and absence of artifacts over the resection area observed at CT scan postoperatively.