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Lung cancer is a major cause of morbidity and mortality worldwide. Metastasis can be seen in many organs in advanced-stage disease. Acral metastasis rate in cancer is quite low. However, because of the direct opening of the arterial circulation, the risk of acral metastasis stem from lung cancer is higher than any other cancers. Although the mechanism is not known exactly, acral metastases occur in dominant extremities. Here, we present a case with lung adenocarcinoma metastasis of the left hand in the second phalanx. We presented this case which is rarely seen in the literature to emphasize acral metastases.

Antithrombin deficiency, although the rarest thrombophilia, carries the highest risk of thromboembolism. This risk is increased especially for pregnant women due to physiological coagulation changes in pregnancy. Therefore, in cases of positive personal and/or family history of thromboembolic events as well as recurrent pregnancy loss women should be tested for antithrombin deficiency. Antithrombin deficiency is caused by numerous mutations of serpin peptidase inhibitor clade C 1 gene (SERPINC) and is classified according to antithrombin plasma activity and antigen levels into Type I (quantitative defect) and Type II (qualitative defect). Complications during pregnancy can be divided into those regarding the mother and those concerning the fetus. The main clinical manifestation of antithrombin deficiency regarding the mother is thromboembolism occurring spontaneously or recurrently during pregnancy. Numerous major gestational complications such as miscarriage, intrauterine growth restriction or fetal death, placental abruption, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome can be linked to antithrombin deficiency. Close monitoring with early and adequate prophylaxis and treatment nowadays can mostly assure the positive pregnancy outcome for both mother and child. Prophylaxis/therapy with both low molecular weight heparin and antithrombin concentrate should start as soon as pregnancy is planned or at least as early as possible in pregnancy and continue until the end of the puerperium.

Background: COVID-19 is the extreme smash of the present-day century that emaciated fitness, financial system, and ordinary life.Objectives: This research assessed the condition and relation of tests, infections, recoveries, and deaths of SARS-CoV-2 from January to May 30, 2022. Methods: The research plan was carried out from January 1 to May 31, 2022 (n = 151 days) to state the position of Bangladesh towards widespread COVID-19. The facts in this study became acquired from extraordinary government groups.Results: The total cases, infections, recoveries, and deaths were 2633750, 367208, 357309, and 1053, respectively, during the study period. In January 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 987194, 213294, 19112, and 315, respectively. In February 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 922657, 143744, 250422, and 643, respectively. In March 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 353555, 5810, 49727, and 63, respectively. In April 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 152691, 977, 12490, and 7, respectively. In May 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 127950, 1016, 6166, and 4, respectively. The maximum and the minimum number of COVID-19 tests were 49492 and 1653 on January 25 and May 4, respectively. The maximum and the minimum number of COVID-19 infestations were 16033 and 1653 on January 22 and May 5, respectively. The maximum and minimum number of COVID-19 recovered were 13853 and 1653 on February 13 and May 9, respectively. The maximum and the minimum number of COVID-19 death was 43 and 0 on February 8 and in several days in 2022, respectively. In the 0.01 level of the two-tailed Spearman, the relationship was positive to moderate to strong relationships and the total number was n=151. The mean Spearman correlation for tests was 0.83 (range 0.973 to 0.633), for infested was 0.81 (range 0.579 to 0.973), for recovered was 0.61 (range 0.633 to 0.618), for death was 0.81 (range 0.553876 to 0.618). This research additionally showed a moderate to strong relationship between tests, infections, recoveries, and deaths of SARS-CoV-2.Conclusion: COVID-19 has spread out unexpectedly to 64 districts in Bangladesh. The persevering with the occurrence of COVID-19 infections has emphasized the significance of the short and accurate and advanced 118 laboratory diagnoses to restriction it unfolds. In this situation, human beings must keep away from public gatherings as plenty as possible and pass return home as speedy as possible after finishing work in a public place. It is safer now because the vaccine controlled the infestation and death rate of COVID-19 in Bangladesh.

Bronchial asthma, is a quite common disease characterized by the chronic inflammation of the airways. It is due to the interaction of genetic with environmental factors. Currently, bronchial asthma is regarded as a public health problem, since its prevalence is constantly increasing worldwide. Common symptoms associated with asthma include repeated episodes of wheeze, dyspnoea, chest tightness and cough. Although commonly most asthmatic episodes are resolved with medical treatment, at times serious complications can deteriorate the clinical picture. Among these complications, the simultaneous spontaneous bilateral pneumothorax, the subcutaneous emphysema and the pneumomediastinum are life threatening complications.

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

Okra is an herbaceous hairy annual plant that belongs to the family Malvaceae. It is cultivated in tropical, subtropical, and warm temperate regions around the world. The present work was carried out to study the effect of biofertilizers (Azotobacter + Bacillus) and different concentrations of Nitrogen, Phosphorus, and Potassium i.e.NPK on growth and photosynthetic pigments of okra (Abelmoschus esculentus L. Moench). Okra can be named a multipurpose crop as its various parts such as leaves, buds, flowers, pods, stems and seeds can be used for different purposes [1]. Okra is rich in dietary fiber, vitamins, oils, etc. Application of hazardous fertilizers causes a nutrient imbalance in soil, With respect to reducing the causes due to chemical fertilizers, biofertilizers are suited best to maintain higher productivity and yield of crops. Random block design (RBD) was selected as an experimental design. The treatments combination taken are T0- Control, T1- Azotobacter + 50% NPK, T2- Azotobacter (2.5 kg/ha) + 100% NPK, T3- Bacillus (2.5 kg/ha) + 50% NPK, T4- Bacillus (2.5 kg/ha) + 100% NPK, and T5 with NPK 100%. The final result revealed, that the treatment combination with Azotobacter + 100% NPK (T2) showed the highest value of plant height (65.60 cm), number of leaves per plant(62.36), number of flowers per plant (27.40), and also carotenoid content (2.82 mg/g), chlorophyll a(2.47 mg/g) and chlorophyll b(3.25 mg/g) were observed maximum. So, it can be concluded through this paper that the combination of Azotobacter 2.5 kg/ha + 100% NPK (T2) is suitable for the okra plant for better growth and enhancement of photosynthetic potential in-field practices.

Aim and objectives: The primary aim was to measure the sperm DNA damage and to study the magnitude of sperm DNA damage. Secondary objective was to study the effect of sperm DNA fragmentation on Day 5 Blastocyst expansion (graded 1-5). Results: There is an increase in sperm DNA fragmentation with an increase in age. Increased sperm DNA fragmentation is also associated with abnormal motility and morphology in semen samples. However, there is no reduction in expansion or grade of blastocyst. Conclusion: Sperm DNA fragmentation testing is a useful investigation in unexplained infertility. However, Sperm DNA fragmentation has no significant association with Day 5 embryo grade in ICSI cycles. Thesis work of Fellowship in Reproductive Medicine student: Dr. Ramya Harish

This case suggests that POEMS syndrome does present with a constellation of signs and symptoms that may lead a clinician to a multitude of other possible diagnoses. Diagnosis is often difficult and delayed. A good history and physical examination as well as a careful review of all workups are paramount in establishing this particular diagnosis. The major criteria of diagnostic for the syndrome are polyradiculoneuropathy, clonal plasma disorder, sclerotic bone lesions, the presence of Castleman disease, and elevated vascular endothelial growth factor. Minor features include organomegaly, extravascular volume overload, endocrinopathy, characteristic skin changes, papilledema, and thrombocytosis. The diagnosis is made with three of the major criteria, two of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria. In this article, we discuss the differential diagnosis and outline the clinical evaluation indicated.

Endometrial Stromal Sarcoma (ESS) is a rare gynecological malignancy originating from endometrial stromal tissue. Representing only a tenth of uterine malignant tumors, ESS is categorized into Low-Grade (LGESS) and High-Grade (HGESS) based on nuclear division. Interestingly, prognostic studies have found no strong correlation between ESS prognosis and nuclear division activity. Undifferentiated Uterine Sarcoma (UUS) represents a spectrum of tumors with varied morphological, clinical, and prognostic features, and lacks a standardized naming convention. In 2014, the World Health Organization grouped ESS into LGESS, HGESS, and UUS based on clinical and pathological attributes. HGESS, despite its rarity, is notorious for its poor prognosis and low survival rate. Its early detection is complicated due to its asymptomatic presentation and ambiguous pathogenesis, leading to debates over treatment approaches. This article delves into the recent research developments concerning HGESS.

Trans-radial uterine artery embolization (UAE) is acknowledged as a non- invasive, cost-effective and safe procedure for the treatment of symptomatic fibroids. However, it is associated with the recurrence of symptoms like abnormal uterine bleeding and pressure symptom in some patients. This is a comparative study of our data with other international data, in the context of percentage reduction in fibroid size, accompanying controlling factors, short and long term follow up data analysis of the first two years was done. Careful pre-procedural counseling of future possibility of fibroid recurrence and means of management should be stressed. Materials and methods: A retrospective cohort study at the Security Forces Hospital in Riyadh, Saudi Arabia, was conducted. The study was done from 1st November 2017-31st October 2019, on symptomatic patients diagnosed with fibroids, who refused surgical treatment. The outcomes included: fibroid site, size and anatomical position, patients’ symptoms, general condition, and early and delayed complications. These data were compared with those from other international studies. Results: The study involved 23 patients (mean age: 39 years). The average percentage reduction in fibroid volume was 49%. There were no major complications and no recurrence of symptoms during the covered period. Data analysis revealed a poor correlation between the overall percentage reduction of fibroid size with fibroid number, age of patients’, and body mass indices. Conclusion: Despite poor correlation, we provided preliminary data of the first two years out of the total five-year projected period of the study where it showed effectiveness and relative safety of radial - UAE for fibroid.