Goodpasture syndrome is a rare immunologically based clinical entity that is characterized by rapidly progressive glomerulonephritis, diffuse pulmonary hemorrhage, and the presence of circulating autoantibodies against the glomerular basement membrane (GBM). Concomitant central nervous system (CNS) manifestations are an unusual presentation of GSP in the absence of ANCA. We present a case of atypical course of the disease in a 48-year-old female patient who started with the presence of hemoptoic sputums and manifestations of uremic syndrome in the presence of high titres of glomerular basement anti membrane antibodies (Ac-anti-MBG) and negative ANCA, with a report of diffuse active extracapillary proliferative glomerulonephritis biopsy, of the pauciimmune type. After immunosuppressive treatment and plasmapheresis, the patient presented decreased anti-MBG Ab titres, as well as improvement of symptoms, however without recovery of renal function on hemodialysis, after 2 months he presents clonic-tonic seizures crisis, we conclude that PGS with neurological involvement is extremely rare, especially with negative ANCAs.

Cutaneous tuberculosis is dangerous. The M. tuberculosis complex causes 1.5–3% of extrapulmonary cases. This chronic illness needs long care. Tuberculous primary complex, commonly known as primary inoculated tuberculosis, is a rare (1%) clinical and histological diagnosis. To provide a histopathological case of primary skin tuberculosis with an unusual clinical presentation and immunization mechanism, to emphasize the significance of early detection to minimize sequelae and infections. A 52-year-old man has rheumatoid arthritis and systemic hypertension. It started with a unilateral localized dermatosis affecting the head in the left malar region characterized by an erythematosus papule of 2 mm in diameter, which at 2 weeks evolved into a 3 mm ulcer accompanied by pain and edema. The injury evolved every month to malar region, eyelids and left atrial pavilion consisting of a 15 cm erythematous myxedematous plate, was evaluated and treated with multiple antimicrobials without improvement, trauma was ruled out, skin biopsy was taken in the presence of two alcohol-resistant acid bacilli and by computed tomography infection by mycobacteria was excluded, skin tuberculosis was diagnosed of the primary skin complex type and treatment was initiated showing clinical improvement at 4 weeks and resolution at 8 months of treatment. The diagnosis of cutaneous tuberculosis presents a significant challenge owing to the diverse range of morphological manifestations. The manifestations observed in these cases have the ability to imitate various skin diseases, encompassing both infectious and non-infectious conditions. Moreover, it is imperative to exclude the existence of systemic tuberculosis in every instance.

Life evolves, and habits change as situations change, such as those experienced in 2019, when the entire community was taken by surprise by the appearance of an unknown virus SARS-CoV-2. Faced with this unknown, health policymakers put in place regulations to protect populations in each of the countries affected. As a result, the habits of people living with a chronic disease such as sickle-cell anaemia had to be changed. However, it is important to understand how the COVID-19 pandemic contributed to the change in the way Gabonese people living with sickle-cell anaemia used hospital facilities for their regular medical check-ups. We therefore carried out a field survey involving a questionnaire sent to the heads of households in the four administrative districts of the commune of Franceville. The main information obtained from these questionnaires is as follows. Most sickle-cell subjects (64.40%) had no difficulty in accessing healthcare services during the Pandemic. Only 11.10% had difficulties, and the remaining 24.50% refrained from going to hospital. When it comes to accepting the vaccination against the SARS-CoV-2 virus, the response was hundred percent negative. In general, most of this segment of the population had changed their habits on hospital medical consultations, which have been transformed into telephone consultations, videoconferencing, or self-medication.

Background: Neonatal sepsis is a clinical syndrome of bacteremia with systemic signs and is the most important cause of neonatal death in developing country. Mortality increase with delay in diagnosis and initiation of antibiotics. So, improvements in diagnosis and management of sepsis can significantly decrease the sepsis complications and improve its outcome. Objectives: The current review aims to high light on the incidence of neonatal sepsis, classification, risk factors, causative organisms, pathophysiology, prognosis, clinical manifestations, complications, systemic examination, and treatment. The incidence of neonatal sepsis varies among the different geographic areas, the highest being registered in Africa and Asia and the lowest in the U.S.A and Australia. The sepsis has been classified as early-onset sepsis (EOS) and the late-onset sepsis. Late-onset infections onset after 1 month of life, which occurs particularly in VLBW preterm infants or term infants requiring prolonged neonatal intensive care for other chronic problems. Neonatal sepsis includes maternal risk factors and neonatal risk factors. Septic or traumatic risk factors delivery, maternal poverty, pre-eclampsia, cardiac disease and diabetes mellitus are significant risk factors. Prolonged rupture of fetal membranes before the onset of labour, chorio-amnionitis, and maternal genitourinary tract infections have been significantly associated with a wide range of adverse perinatal and maternal outcomes, including miscarriage, stillbirth, preterm birth, fetal growth restriction, neonatal and puerperal sepsis, neonatal encephalopathy and neonatal and maternal mortality. Improvement in the socio-economic status of the population and availability of affordable antenatal care would reduce the incidence of neonatal septicemia. Amniocentesis, cervical cerclage, transcervical chorionic villus sampling, or percutaneous blood sampling, can permit entry of skin or vaginal organisms, causing amnionitis and secondary fetal infection. Infection of skin abrasions after use of obstetric forceps increases the risk of infection in neonates. Infant birth weight is inversely related to risk of early- onset sepsis. Prematurity and low birth weights are the most important neonatal factors predisposing to infection. Endotracheal intubation, insertion of an umbilical vessel catheter, or both, is associated with an increased risk of bacterial infection. Prolonged intravascular access and mechanical ventilation, the use of intravenous intralipids, and the duration of total parenteral nutrition are among the proposed risk factors associated with NICU-acquired coagulase- negative staphylococcus infections. Males have an approximately two-fold higher incidence of sepsis than females. Systemic antibiotics potentiate the overgrowth of certain organisms as Staphylococcus epidermidis. Corticosteroid treatment increases the risk of invasive candidiasis among premature infants. Hospital Acquired Infections are one of the leading causes of mortality and morbidity in (NICU). Group B Streptococcus (GBS) and E. coli as the dominant early onset sepsis (EOS) pathogens and coagulase- negative staphylococci (CONS) as the dominant late onset sepsis (LOS) pathogen followed by GBS and Staph aureus. In developing countries, Gram negative organisms are more common and are mainly represented by Klebsiella, E.coli and Pseudomonas of the Gram positive organisms, Staph aureus, CONS, Streptococcus pneumoniae, and Streptococcus pyogenes are most commonly isolated. Agents that commonly cause nosocomial infection are coagulase-negative staphylococci, gram-negative bacilli, Enterococci, and S. aureus. Causative organisms are bacterial, fungal, viral, and protozoal organism's infections. Mode of infection is prenatal, natal, and postnatal infections. Soon after birth, the newborns are exposed to the "hostile world" of bacteria, viruses, fungi and parasites, so they must immediately defend themselves. Necotizing enterocolitis, Neonatal thrombocytopenia, endophthalmitis, abdominal aortic-iliac thrombosis, fatal complete atrioventricular block, and wide range of signs and symptoms that may be observed in neonates with septicemia frequently suggest a number of alternative diagnoses. Identification of infection may be made by isolating the etiologic agent from a sterile body fluid (blood, CSF, and urine), or by demonstrating endotoxin or bacterial antigen in a body fluid. Investigations are including isolation of the microorganism, blood culture, urine culture, tracheal aspirate culture, isolation of organisms from CSF, complete blood cell count, cerebrospinal fluid analysis, C-Reactive protein, and tissue release of procalcitonin. Purpose of supportive care is to normalize the temperature, stabilize the cardiopulmonary status, correct hypoglycemia, and prevent bleeding tendency. Treatment of sepsis includes antibiotics, antiviral, antifungal, intravenous immunoglobulin, granulocyte transfusion, .......

Mucinous appendiceal tumors consist of mucinous adenocarcinoma, low-grade appendiceal mucinous neoplasm, and high-grade appendiceal mucinous neoplasm. The incidence of non-mucinous adenocarcinomas is reduced. The most recent edition of the World Health Organization classification and recent consensus guidelines will enable the consistent application of agreed nomenclature. Not only is precise diagnosis essential for effective patient management, but it also facilitates the comparison of results across centers and tumor registries. The most prevalent benign adenoma in the appendix is serrated. It is imperative to differentiate these conditions from low-grade appendiceal mucinous neoplasms, as the latter can also resemble harmless ailments. Adenocarcinomas of the goblet cells are a rare subtype of appendiceal neoplasm. While appendiceal neoplasms are uncommon, they are not entirely so, and even the most seasoned pathologists may find them difficult to diagnose. In addition, appendiceal neoplasia classification and terminology have been subjects of contention for decades. Nonmucinous appendiceal neoplasms are less prevalent than mucinous tumors, and their association with other appendiceal neoplasm subtypes remains uncertain. A literature review of appendiceal mucinous neoplasms identified during laparoscopic appendicectomies is presented here.

Biotransformation in human body results accumulation of free radicals (reactive oxygen species or ROS). If patients LDL particles are more than normal in systemic circulation, get interacted with free radicals and form foamy cells; initial stage of coronary artery disease (CAD). Hyperlipidemia may be primary (genetic reason) or secondary which is acquired type of dyslipidemia. Free radicle formation in human body is very much normal phenomenon. Just reducing LDL or raising HDL may prevent interaction of LDL with reactive oxygen species (free radicals), escaping patient to develop CAD. Commonly used drugs in prophylaxis or treatment of dyslipidemia include statins (HMGCo-A reductase inhibitors), niacin, bile resins and fibric acids. There are alternative therapies for dyslipidemia including use of fibers, fruits, and vegetables. In Pakistan there are huge number of fruits and herbs which are getting popularity as hypolipidemic agents. One of the important fruit in Pakistan having hypolipidemic potential is JUJUBES (in urdu called Bair). In this study we have compared hypolipidemic effects of Bair with statin in hyperlipidemic patients. This study was conducted at Begum Jan hospital, Islamabad-Pakistan. Sixty hyperlipidemic patients were selected and divided in two groups. Their lipid profile (LP) was determined in the hospital and blood pressure (BP) was recorded at start of treatment. Group-1 was advised to take 10 mg tablet Rosuvastatin in divided doses, and group-2 was advised to use 500 mg Bair (JUJUBES) in divided times per day for the period of 2 months. RESULTS: after two months therapy their lipid profile and BP was re-determined and analyzed statistically by using SPSS version 22.00.01. It was observed that Rosuvastatin decreased systolic BP and LDL-c highly significantly (p-value < 0.001), while diastolic BP was reduced significantly (p-value <0.01) and HLD-c was increased significantly with p-value <0.01. In group-2 JUJUBES (Bair) reduced systolic BP and LDL-c significantly (p-value <0.01) but no significant changes were observed in diastolic BP and HDL-c in this group. CONCLUSION: It was concluded from the research study that Jujubes reduce LDL-c and systolic BP in hyperlipidemic patients, but lesser than statin group of antihyperlipidemic agents.

An important motive for preventive paediatric cardiology is the fact that vascular atherosclerotic lesions may develop in early life. A high risk strategy has been advocated to identify children with hypercholesterolaemia both in the United States (US National Cholesterol Education Program for Children and Adolescents, NCEP-Peds) and European countries including Sweden. The major indicators for lipoprotein screening are a family history of premature CAD and/or a parental serum cholesterol concentration 6.20 mmol/l or greater. A major problem is that the parents are usually quite young and that many children live in one parent households. With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. View an illustration of coronary arteries. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot. The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor. In this work we compared hypolipidemic effects of Niacin with Cardamom. Seventy five hyperlipidemic patients were selected for research work. They were divided in three groups. Group-I was on placebo, group-II was given 1.5 grams Niacin, and group-III was advised to use powdered Cardamom thrice daily for the period of two months. Their lipid profile was measured at start of research and then on day-60. After two months therapy group-II reduced total cholesterol 30.8 mg/dl and LDL cholesterol 12.1 mg/dl and increased HDL cholesterol 5.6 mg/dl. In group-III Cardamom decreased total cholesterol 7.2 mg/dl and LDL cholesterol 8.8 mg/dl. HDL cholesterol in this group increased 4.9 mg/dl. When results were compiled and analyzed biostatistically, these changes were significant. We conclude from the research work that Niacin has more effects on total cholesterol but effects of both drugs on LDL cholesterol reduction was almost same. KW: serum fats, heart, oxidative stress, heart, prevention, niacin, green illaichi.