Introduction: Sleep, an essential therapeutic part of human physiology, Sleep problems was widespread among students in medical colleges, and excessive stress and the pressure of holding grades can affect their sleep quality. The relationship between sleep, stress and cognition/learning is far more complex than perceived. Material and Method: Cross sectional study was conducted in Al-Kindy College of Medicine, during the period from (2022 to 2023) academic year. The electronic questionnaire was distributed among all students. Analysis of data was carried out using IBM SPSS version 24. Results: A total of (500) medical students' online surveys were analyzed from AL-Kindy College of Medicine, The highest number of participants was from the fifth year with (114) students, and percentage of (22.8%), whereas the lowest number of participants was from the second year with (68) students (13.6%). There were about (258) male with percentage of (51.6%), and (242) female with percentage of (48.4) participated in this study. The majority of students (160) with percentage of (32%) were sleeping (6) hours/day, and a minority (1) student with percentage of (0.2%) had 3 hours sleeping/day. There was a significant relationship between sleep hours and sleep deprivation like, about (297) students, with prevalence of (59.4%) agreed that sleeplessness negatively affected their academic performance, while (41) students with percentage of (8.2%) disagreed. According to the effect of stress, the prevalence of sleep disorders among undergraduate medical students was shown that (169) students with percentage of (33.8%), were always stressed, while (34) students with percentage of (6.8 %), were rarely affected by stress. According to the causes of stress, the majority of students (198), with percentage of (39.6%), were had too much study, while (1) student, with percentage of (0.2%), was had no significant reason. Other (174) students, with percentage of (34.8%), were under stress because of exams and (127) students, with percentage of (25.4%), were under stress because of life events. Conclusions: Sleep disorders are common among medical students. The study also reveals that there is a strong, positive and significant relationship between stress levels sources of stress and sleep deprivation which is associated with poor academic performance. Recommendations: Keeping bedtime and wake time consistent, including on weekends. Regular activity helps promote a good night's sleep. Also schedule exercise at least a few hours before bedtime and avoid stimulating activities before bedtime. Further research is required in this field.

Background: Breast cancer is the most common cancer among women across the world. Various treatment modalities in terms of radiotherapy, chemotherapy or surgery along with several neoadjuvant or adjuvant therapies are already established for the better survival of the patients. New modalities are still under research every other day for improvement of quality of life of cancer victims. Objective: This case series was conducted to assess the efficacy and safety profile of primary breast cancer patients by adding Paclitaxel to the established regimen of Epirubicin and Cyclophosphamide. Methods: This was performed during January 2019 to January 2021 with 9 cases of clinically diagnosed breast cancer patients at Combined Military Hospital, Dhaka. Patients included in our study received Epirubicin in the dose of 75-100 mg/m2 dl, Cyclophosphamide 600 mg/m2 dl, every 3 weeks for a total of 4 cycles followed by Paclitaxel at a dose of 175 mg/m2, every 3 weeks for a sum of 4 cycles. After every cycle of neoadjuvant chemotherapy and at the end of it, response was assessed by ultrasound. Results: The findings revealed 6 out of 9 patients showed pathological complete response at the end of this neoadjuvant regimen. The remaining 3 cases showed partial response. Toxicity was minimal and well-managed. 5 patients developed leukopenia in terms of haematological events, whereas for other effects, nausea and fatigue was commonly encountered. Conclusion: Overall, this treatment modality turned out to be feasible and a good option for neoadjuvant therapy in terms of efficacy and safety profile for the breast cancer patients.

M. abscessus var. abscessus and M. abscessus var. massiliense are fast growing non-tuberculous mycobacteria that cause skin and soft tissue infections. We present a 32-year-old female that initiated her current condition two years ago prior her medical assessment due to an event of cellulitis in the front part of her legs and later on being in contact with contaminated water. Two weeks later after the exposure she developed a dermatosis in the same region characterized by disabling pain, intermittent fever and edema without achieving improvement after being treated with multiple topic treatments. For these reasons, extension studies were carried out to get to the diagnosis of infection related to Mycobacterium abscessus var. massiliense, this gave the opportunity to give a successful therapeutic approach. Finally, after being treated for a month, an adequate evolution was obtained.

Pulmonary Tuberculosis has diverse radiological presentations such as consolidation, cavitation, airway disease, pleural effusion and lymphadenopathy. Pneumonia-like presentation in tuberculosis is very commonly reported in Pulmonary Tuberculosis. Fissural effusion is common in cardiac failure and isolated fissural effusion is rarely described in literature with etiology as tuberculosis. Round pneumonia is commonly described in pediatric cases with community acquired pneumonia and also frequently reported in childhood pulmonary tuberculosis. Round pneumonia is very infrequently reported in adults with pneumonia and to very few published data as due to tuberculosis. In this case report, a 21-year female, presented with constitutional symptoms for 3 months duration with partial response to medical treatment received in line with pneumonia, bronchial asthma and bronchitis. Radiological investigations documented round opacity in right mid-zone with no adventitious breath sound on clinical examination. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax and documented loculated right horizontal fissural effusion with subpleural parenchymal opacity in right upper lobe posterior segment and right middle lobe lateral basal segment with peri-consolidation satellite nodules in right posterior segment. We have done bronchoscopy due to negative induced sputum microbiological workup. Bronchoscopy guided BAL microbiological workup documented MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test and negative BAL smear for AFB. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms and typical radiological features such as ‘round pneumonia or fissural effusion’ in absence of other causes for the same. Fissural effusion or round pneumonia due to tuberculosis is rare in adults but not uncommon. Bronchoscopy is a gold standard test to confirm etiological diagnosis due inadequate or poor quality of induced sputum sample in cases with round pneumonia and fissural effusion. Isolated Fissural effusion secondary to pulmonary tuberculosis is extremely rare in medical literature and this will be first case reported till date.

COVID-19 pandemic is over now and we are in great peace of relief after three years. This pandemic has observed significant impact on quality of life globally and the put unforgettable imprints on history of mankind. Reason for more havoc in this pandemic was less studied virus by medical scientists regarding its pathophysiology, available treatment options and lack of effective vaccine to tackle this dragon. COVID-19 is the first observed and reported pandemic of corona virus related global disease apart from its previous SARS and MERS. Fast track developments in medical treatment options due to this ultrafast digital and artificial intelligence techniques have curtailed mortality on large scale globally. Although mortality is significantly reduced, morbidity is documented on a large scale worldwide in this pandemic. Morbidity due to COVID-19 now called as ‘Long COVID’, which is underreported & half-heartedly evaluated globally. Long COVID is related to persistent immune dysregulation occurs during evolution of COVID-19 as natural trend of disease. Immune dysregulation has documented during course of active viremia, during recovery of viral illness and after post viral phase. Immune dysregulation occurs in ‘selected group’ of cases irrespective of disease severity and vaccination status and observed in cases with negligible illness to advanced one mandates further research. Thus, Immune dysregulation in COVID-19 is predominant cause for long covid and leading to brainstorming effect on medical scientists and researchers as of today. Globally, one third of recovered or affected cases of COVID-19 are facing long covid and needs prompt treatment options to tackle this dragon related long term effect on body. ‘Immunomodulatory’ or immunity modifying agents are the primary targets to curtail immune dysregulation and long covid. Some experts recommend ‘disease modifying agents’ to treat long covid cases. Still, many miles to go to reach to effective treatment options for long covid and we don’t have effective options for this ‘health issue of global concern’. L-Arginine is amino acid with multiple beneficial effects such as immunomodulatory effects which will regulates immunological response in inhibit dysregulated immune system additional to its universally known antioxidant, vasodilatory and regenerative and cellular proliferation effects on immune cells. These Immunomodulatory and or diseases modifying effects of L-Arginine makes it the future candidate with ‘game changer’ role for management of Long covid resulting from immune dysregulation as a core pathophysiologic pathway of this Dragon Pandemic.

The article examines the contribution of real-time three-dimensional transesophageal echocardiography (3D TEE) in the assessment of ostium secundum atrial septal defects (ASD) in adults. 3D TEE provides a precise and comprehensive view of cardiac anatomy, enabling the evaluation of size, shape, and border quality of the ASD. In a series of 27 cases, 3D TEE demonstrated a strong correlation between 3D-measured ASD parameters and the size of the closure device required. This technique is crucial for accurate pre-interventional evaluation, enhancing the success and safety of percutaneous or surgical interventions for ostium secundum ASD. Three-dimensional transesophageal echocardiography represents a significant advancement in cardiovascular imaging for complex structural heart abnormalities.