Introduction: Chronic kidney disease (CKD) is commonly associate ed with hypertension, diabetes mellitus, anemia, fluid and electrolyte disturbances, mineral-bone abnormalities, and cardiovascular disease, resulting in the use of multiple medications. Altered renal elimination and the frequent requirement for dose modification make rational prescribing particularly important in this population. Objective: To evaluate the pattern of drug utilization and associated clinical outcomes among patients with chronic kidney disease attending a tertiary-care teaching hospital. Materials and Methods: A prospective observational study was conducted in the Department of Pharmacology in collaboration with the concerned clinical departments at Chirayu Medical College&Hospital, Bhopal, Madhya Pradesh, from February 2015 to January 2016. One hundred adult patients diagnosed with CKD were included. Demographic characteristics, CKD stage, associated comorbidities, medications prescribed, route of administration, generic prescribing, use of essential medicines, and selected clinical and laboratory outcomes were recorded. Drug utilization was evaluated using World Health Organization prescribing concepts. Clinical outcomes included blood-pressure control, change in hemoglobin, serum creatinine and estimated glomerular filtration rate (eGFR), need for dialysis, symptomatic improvement, adverse drug reactions, hospitalization, and mortality. Results: The mean age of the study population was 55.8 ± 13.1 years, and 61% were male. Hypertension was present in 78%, diabetes mellitus in 46%, and anemia in 68% of patients. Stage 4 CKD was the most frequent stage (31%), followed by stage 3 (29%) and stage 5 (25%). A total of 612 medications were prescribed, corresponding to 6.12 ± 2.03 drugs per patient. Antihypertensive agents were the most frequently prescribed drug group (86%), followed by hematinics/erythropoiesis-stimulating therapy (68%), gastrointestinal drugs (55%), calcium and vitamin D preparations (47%), diuretics (44%), antidiabetic agents (42%), phosphate binders (38%), and antiplatelet/hypolipidemic agents. At follow-up, satisfactory blood-pressure control was achieved in 64.1% of hypertensive patients. Mean hemoglobin increased from 8.9 ± 1.7 to 9.8 ± 1.6 g/dL among anemic patients. Renal function remained clinically stable in 58% of the cohort, deteriorated in 27%, and improved in 15%. Twenty-five patients required maintenance dialysis. Adverse drug reactions were observed in 13% of patients. Overall, 71% showed symptomatic improvement or clinical stability, 20% had disease progression requiring intensification of therapy or hospitalization, and four patients died during follow-up. Conclusion: Patients with CKD were exposed to considerable polypharmacy because of multiple disease-related complications and comorbidities. Antihypertensive agents, anemia-related therapies, mineral-bone disorder treatments, and diuretics accounted for a major proportion of drug use. Appropriate selection and renal dose adjustment of medicines were associated with satisfactory control of blood pressure and improvement in anemia in a substantial proportion of patients. Regular prescription review and pharmacological monitoring are essential to promote rational drug use and improve outcomes in CKD.

Introduction: Colorectal cancer (CRC) is a major global health concern, with multifactorial etiology involving genetic, environmental, and lifestyle factors. The ABO blood group system, influencing immune response, inflammation, and cell adhesion, may contribute to CRC risk. Variations in antigen expression impact tumor progression, metastasis, micro biome interactions, and coagulation, warranting further investigation. Aim of the study: The aims to assess the relationship between ABO blood group and the risk of colorectal cancer (CRC). Material and Methods: This retrospective study examined the association between ABO blood groups and colorectal cancer risk among patients at BSMMU, Dhaka, Bangladesh. Data from medical records of diagnosed patients between July 2016 to December 2016 were analyzed with 92 patients from different blood group. Ethical approval was obtained, and confidentiality was maintained. Inclusion criteria encompassed patients aged ≥18 years with confirmed colorectal cancer and ABO blood group typing. Data on demographics, clinical history, tumor characteristics, and diagnostic methods were collected. Statistical analysis was conducted using SPSS (Version 26), with continuous variables analyzed via Student’s t-test and categorical variables via the Chi-Square test. A p-value <0.05 was considered significant. Result: The study highlights significant variations in demographic and clinical characteristics of colorectal cancer patients across ABO blood groups. Blood group O was most prevalent, with a higher proportion of younger individuals and males. Blood group AB was exclusively found in older patients. Obesity was common in group A, while Rh negativity was universal in group AB. Group O had the highest rates of smoking, hepatitis history, and family history of colorectal cancer. Although tumor characteristics varied, statistical significance was not consistently observed. Blood group AB was significantly associated with increased colorectal cancer risk, alongside smoking and family history. Conclusion: This study found a significant association between ABO blood groups and colorectal cancer risk in a Bangladeshi population, with blood group AB showing the highest risk. Group O exhibited unique clinical patterns, indicating potential immunological and metabolic mechanisms influencing CRC pathogenesis alongside comorbidities and screening uptake variations.

Introduction Diabetes mellitus (DM) is one of the most frequently occurring endocrine disorders characterized by the common phenotype of hyperglycemia. It is a growing health care problem worldwide and is characterized by metabolic abnormalities such as diabetic ketoacidosis and non-ketotic hyperosmolar coma and leads to complications involving the eyes, kidney, nerves, blood vessels and the gastrointestinal tract. Methods This is a prospective study was conducted in the Department of General Medicine, Mahavir Institute of Medical Sciences. Fasting blood was collected. Serum total Hcy was measured with cycling enzymatic method. Serum total Hcy concentration of <15 mol/L was considered normal. Serum folic acid and vitamin B12 were detected with electrochemiluminescence immunoassay. Glucose was determined enzymatically. Glycosylated haemoglobin (HbA1c) was measured using high performance liquid chromatography. Results A total of 160 type 2 diabetic patients were included in the study. The mean age of the participants was 55.4 ± 9.8 years, with 88 males (55%) and 72 females (45%). The mean duration of diabetes was 8.2 ± 4.6 years. A significant positive correlation was observed between serum homocysteine and HbA1c (r = 0.41, p < 0.001), suggesting that higher homocysteine levels are associated with poor glycemic control Serum homocysteine also showed a strong positive correlation with serum creatinine (r = 0.55, p < 0.001), indicating an association with declining kidney function An inverse correlation was found between serum homocysteine and eGFR (r = -0.48, p < 0.001), suggesting that higher homocysteine levels correspond to lower renal function. Conclusion The findings indicate that elevated serum homocysteine levels are significantly associated with poor glycemic control and declining kidney function in type 2 diabetic patients. Monitoring homocysteine levels may provide additional insight into the risk of diabetic nephropathy and vascular complications. Further studies are needed to establish causality and potential therapeutic targets for homocysteine reduction in this population

The necessity for ‘therapy’ now seems to be deeply ingrained in our culture and the army of pop psychologists and psychiatrists, non-biological therapists, and agony aunts increases, it seems, by the day. In the media what is quoted as ‘research’ and passed off as science, is often no more than a street survey, or opinion poll on a current fad or passing headline grabber, rather like those ‘we asked a hundred people’ questions posed on popular family quiz shows. The therapy bandwagon rolls on and is quite lucrative if you are fortunate enough to capture the market with your own brand of snake oil cure to life’s woes. Admission is free to the Mind Industry and furthermore, there are no compulsory, nationally agreed standards for the conduct and competence of non-medical psychotherapists and counsellors. Even if removed from the membership of their professional body for inappropriate conduct say, therapists can continue to practise, there being no legal means to prevent them from doing so. Most members of the public are unaware of this lack of statutory regulation. It is not surprising then that many ‘therapists’ flagrantly sell their product and any attempt to question the authenticity of a particular ‘cure’ is met with vitriol and feigned disbelief. After all, one has to guard one’s source of income. The author Richard Dawkins was subject to such venom and hostility when he dared to question the reasons and need for religion in his book The God Delusion. Woe betide any practitioner who dares to criticise the favourable results of ‘carefully conducted positive outcome studies’ on, say, cognitive therapy, even when one’s own clinical experience attests to the opposite. Of course, some therapies work, some of the time, but not because of the outlandish claims made for them; rather, they work best when a ‘client’ harnesses the energy and motivation to get better and ‘chooses’ one brand of therapy over

Headaches and sexual activity are often treated with humour as a typical way for women to reject male advances. However, headaches associated with sexual activity can be anything but a joke. HSA (headaches associated with sexual activity) are by definition benign conditions but the symptoms can be the same as in serious life-threatening cerebral conditions and these need to be quickly excluded at the first presentation. Most sexual headaches are of a benign nature. However, the first time an HSA occurs it can be a traumatic, frightening occurrence for the patient. HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition. Patients need to have the situation clearly explained to them so that management can be optimal. However, good overall management of a patient with HSA should also include discussions about possible negative sexual consequences of the HSA experience. Sexuality can be affected by HSA both during the active condition and subsequently. Sexuality must be addressed by the treating physician if the patient/couple are not to be left with an ongoing negative effect on their future sex life as a consequence of the HSA.

A restraint is a device or medication that is used to restrict a patient’s voluntary movement. Reported prevalence of physical restraint varies from 7.4% to 17% use in acute care hospitals up to 37% in long term care in the United States. Prevalence of 34% psychotropic drug use in long term care facilities in the United States has been reported; but use is decreasing, probably due to regulation. Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient. The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Ignorance about the dangers of restraint use results in a sincere, but misguided, belief that one is acting in the patient’s best interest. Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing.

Definition of restraint: a device or medication that is used to restrict a patient’s voluntary movement. Prevalence of physical restraints: up to 17% in acute care settings. Prevalence of chemical restraints: up to 34% psychotropic drug use in long term care facilities. Complications of restraints: include documented falls, decubitus ulcers, fractures, and death. Regulations: require documentation of indications plus failure of alternatives by a licensed professional. Prevention of removal of life sustaining treatment: is a relatively clear indication for restraints. Informed consent: including consideration of risks, benefits, and alternatives is necessary in all cases. Barrier to reducing restraints: a misguided belief that, by use, one is preventing patient injury. Steps can be taken to limit their use: including an analysis of behaviours precipitating their use.