Blunt trauma-induced diaphragmatic hernia (DIH) is a rare but potentially life-threatening condition. Prompt diagnosis and management are crucial for successful outcomes. We present the case of a 40-year-old male who sustained blunt abdominal and chest trauma resulting in a left DIH with extensive gastrointestinal involvement. The patient underwent emergency laparotomy with primary repair of the diaphragmatic defect and resection of gangrenous stomach and bowel segments. Postoperatively, the patient recovered well and was discharged on day 14. Diagnosis of DIH relies on high clinical suspicion and radiological imaging, with CT scan being the modality of choice. Management involves surgical repair, either by primary closure or with the use of mesh, depending on the extent of the injury and presence of infection. Mortality rates are high in emergency repairs, especially when associated with bowel necrosis and perforation. This case highlights the importance of early recognition and timely intervention in DIH. Clinicians should maintain a high index of suspicion for DIH in patients presenting with a history of trauma and respiratory or abdominal symptoms. Improving awareness and understanding of abdominal injuries in trauma centers can help in early diagnosis and appropriate management, ultimately leading to better outcomes for patients with DIH.

Acute retinal necrosis syndrome (ARN syndrome) is a rare, rapidly progressive viral retinitis with a grim functional prognosis. We present a case of a 43-year-old immunocompetent woman who experienced unilateral acute retinal necrosis, with Varicella-Zoster Virus (VZV) infection as the etiology. A unilateral vesicular facial rash accompanied by rapidly declining visual acuity over 7 days prompted consultation. Intravenous antiviral treatment and panretinal photocoagulation laser (PPR) were initiated, followed by antiviral prophylaxis. The patient developed ophthalmic zona lesions, peripheral retinal ischemia, and unilateral macular serous retinal detachment (SRD). Treatment included valacyclovir, corticotherapy and PPR laser. Knowledge of this condition, diagnosed clinically, is crucial due to its rapid progression and severe complications. Early intervention appears to be a significant prognostic factor, emphasizing its therapeutic urgency.

Background: Colorectal cancer (CRC) poses a significant public health burden worldwide, with a notable trend of increasing incidence among individuals aged 20 to 50 years. Understanding the risk factors associated with early-onset CRC is crucial for developing targeted prevention and intervention strategies, particularly in limited-resource settings. Objective: This study aimed to identify and analyze the risk factors contributing to the development of early-onset CRC in a population from a limited-resource country. Method: A comparative study was conducted among 178 CRC patients admitted to the National Institute of Cancer Research & Hospital (NICRH), Dhaka. Patients were divided into two groups: Group-A (age 20-50 years) and Group-B (age >50 years). Demographic and clinical data were collected, and statistical analyses were performed to determine associations between various risk factors and early-onset CRC. Results: The mean age of Group-A subjects was 43.6±7.1 years, significantly younger than Group-B subjects (59.2±9.3 years). Male patients constituted 69.1% of the cohort, with a statistically significant male-to-female ratio of 2.2:1. Higher BMI (≥25) was strongly associated with early-onset CRC (p<0.01). Occupations such as business and middle socioeconomic status were significantly linked to early-onset CRC. Regular exercise (>30 minutes daily) demonstrated a protective effect against CRC development. Consumption of red meat and fast food was associated with a higher risk of CRC, while regular consumption of vegetables was protective. Familial adenomatous polyposis (FAP) presence was significantly associated with early-onset CRC. Conclusions: Male sex, high BMI, specific occupations, dietary factors, and presence of FAP emerged as key risk factors for early-onset CRC. Encouraging regular exercise and promoting healthy dietary habits, particularly reducing red meat and fast-food intake, are crucial in mitigating the risk of early-onset CRC in similar populations.

Background: Pleural fluid analysis and closed pleural biopsy are integral parts in the investigative work up of an exudative pleural effusion. For diagnosis of tuberculous pleural effusion (TPE), the yield of pleural fluid culture for mycobacteria is low at about 36%. Objective: To evaluate the levels of adenosine deaminase (ADA) in the pleural fluids (P-ADA) of untreated and non-surgically manipulated female and male adult patients with several confirmed causes of PES. Methods: This was an observational study conducted at dept. of Internal Medicine, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh from January to June 2023. 100 pleural fluid samples from 100 patients with proven causes of PES. The sample size was appropriate according to the study design. Written consent was obtained from all patients. It was precise enough to calculate descriptive and inferential statistics on type I and II errors, effect size, standard deviation, and was not influenced by administrative issues and costs. Results: 100 patients summarize the prevalence of the causes of PES and the demographic characteristics. TB was the most prevalent cause of PES (28/100, 28%). Most prevalent male sex was in the lymphoma group (4/0, 100%). None of the five patients with lymphoma were female. When the frequencies were compared for males and females, only adenocarcinoma and lymphoma were significant (chi- square tests, p=0.0021 and p=0.0003, respectively). The causes, prevalence, and median P-ADA (n/%/U/L) were tuberculosis (28/28.0/42.0), adenocarcinoma (24/24.0/9.75), transudate (21/21.0/6.85), simple parapneumonic pleural effusions (PPE; 10/10.0/9.38), complicated PPE/empyema (5/5.0/32.9), lymphoma (4/4.0/401.2), squamous cell carcinoma (4/4.0/13.11), and others (4/4/15.2). For P-ADA, Dunn's post hoc test revealed significance for tuberculosis vs. transudates, vs. simple PPE, and vs. adenocarcinoma (all P<0.05), and not significant for CPPE/empyema, lymphoma, SCC, and others (all P>0.05). For age, Dunn’s post hoc test revealed significance for tuberculosis vs. transudates, vs. simple PPE, and vs. adenocarcinomas (all P<0.05). Sex was not significant in the overall PES group (Chi=0.062, P=0.8028). Kendall's correlation of the relationship between P-ADA and age for pleural tuberculosis (n=26) was significant after 1000 iterations with bootstrap for 95% CI (Tau=-0.213, 95% CI - 0.449-0.0833, P=0.0490). A negative LOESS regression was evident between P-ADA and age >40 years. Conclusions: Evaluation of pleural ADA levels is useful for diagnosing pleural tuberculosis, while sex is not. A negative and significant relationship between P- ADA level and age >40 years was evident.

Mesalazine, or 5-aminosalicylic acid, is an anti-inflammatory drug frequently used in patients suffering from chronic inflammatory bowel disease, and is generally well tolerated. Its most common side effects are mainly limited to gastrointestinal disorders, headaches, joint pain and skin rashes, and are generally modest and transient. Serious hematological toxicity is very rare (<1/10000), but cases of thrombocytopenia, aplastic anemia, pancytopenia and leukopenia/agranulocytosis have been reported. We report here the case of a patient with inflammatory phenotype colonic Crohn's disease on mesalazine 3g/day who presented with initial leukopenia aggravated by the development of pancytopenia.

Background: Preeclampsia (PE) develops in 4-5% of pregnancies in humans. It appears after 20 weeks of gestation and is defined by increased blood pressure and proteinuria. When convulsions occur or the hemolysis, high liver enzymes, and low platelet count (HELLP) condition materializes, PE can lead to eclampsia. It is well recognized that eclampsia and HELLP syndrome are linked to serious side effects include liver hemorrhage, lung edema, brain hemorrhage, and renal failure. Objective: The aim of this study is to compare between highly sensitive c- reactive protein in subjects with preeclampsia with severe features and preeclampsia without severe features. Methods: This case-control study was carried out in the Department of Obstetrics & Gynecology of Dhaka Medical College Hospital, Dhaka, from January 2023 to December 2023. A total of 68 patients were enrolled and analyzed in this study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, maximum study subjects were in 21 – 30 years age group. Mean age of the study subjects was 26.12 ± 4.02 and 24.04 ± 4.32 years in PE with severe features and PE without severe features respectively. Majority of the patients 27(79.4%) and 25 (73.5%) were housewife in both cases. Illiterate 2 (5.9%), higher secondary 9(26.5%) and graduate 10(29.4%) were higher in PE with severe features than PE without severe features. Most of the patients 25 (73.5%) and 21 (61.8%) came from rural area. Nullipara was higher in PE with severe feature and multigravida was higher in PE without severe features. Antenatal care was found more irregular in PE patients with severe features subjects than PE without severe features. Preterm pregnancy was higher in PE with severe feature than PE without severe features. Systolic and diastolic blood pressure were found significantly higher in PE patients with severe features than without severe features. hsCRP was found significantly higher in PE with severe features than PE without severe features. APGAR score of the neonate was significantly better of PE patients without severe features than with severe features patients both at birth and at 5 minutes. Average birth weight of the neonate was found higher of the PE patients without severe features than with severe features patients. There was 6(17.6%) very LBW of neonates of PE with severe features patients but none in PE without severe features patients. Intrauterine growth retardation, and prematurity were found higher in PE with severe features patients comparing PE without severe features. Conclusion: Women with PE have higher serum hsCRP levels. Clinical and biochemical markers of PE are linked with elevated serum levels of hsCRP in preeclamptic women. Serum hsCRP levels can be measured to determine the severity of PE.

Background: Medical image analysis plays a crucial role in the screening, monitoring, diagnosis, and prognosis of diseases. Hepatocellular Carcinoma (HCC) often remain asymptomatic in their early stages. Timely identification and intervention are crucial to prevent the progression to decompensated liver diseases and advanced-stage HCC, minimizing morbidity and mortality. Methodology: This study examined twenty relevant research articles that met the inclusion criteria. Utilizing the PRISMA criteria, a systematic search was conducted on PubMed/MEDLINE and Google Scholar for studies on HCC screening employing Artificial Intelligence (AI) and Machine Learning (ML). The search focused on the keywords "artificial intelligence" and "hepatocellular carcinoma," with inclusion criteria specifying studies in the English language published in and after 2020. Exclusions were made for histology, animal research, and investigations conducted before 2020. Titles and abstracts were thoroughly reviewed, and any discrepancies were discussed. Results: The comprehensive review reveals the transformative impact of AI and ML on HCC screening, diagnosis, and therapy. ML models demonstrated effectiveness in early HCC diagnosis, distinguishing hepatic lesions, predicting treatment responses, and assessing recurrence risks across various techniques. Integration of mass spectrometry-based technologies, advanced imaging, and real-world data significantly improved diagnostic accuracy and clinical decision support. AI models exhibited diagnostic expertise with potential applications in therapy suggestions, personalized surveillance, and prognostic evaluations. However, further validation and seamless integration into clinical practice are essential for realizing their full potential. Conclusion: This systematic study underscores the progress made in the application of AI and ML in HCC screening, diagnosis, and treatment. Numerous studies highlight the capability of AI and ML systems to enhance hepatocellular carcinoma diagnosis, predict outcomes, and optimize therapy. The enduring and versatile nature of these technologies points towards a revolutionary future in personalized and efficient HCC management.