The term pelvic floor dyssynergia is commonly used interchangeably with the terms anismus, dyssynergic defecation or puborectalis syndrome. Patients with PFD commonly present with chronic constipation. The prevalence among the general population can range from 20-70% and among constipated patients it has been reported as high as 60%. This defecation disorder is basically caused by failure of relaxation or paradoxical contraction of the external anal sphincter and the puborectalis sling during defecation. Although there is no clear pathophysiological cause for this disorder, it has been linked to several factors such as abuse in childhood, poor toilet training, difficult childbirth, previous pelvic surgery or other psychological factors. The correct diagnosis is key to treating PFD and it starts with a thorough history and physical exam including a well performed digital rectal examination. Appropriate investigations following the initial visit can help to confirm the diagnosis and then treatment is prescribed accordingly. The patient should understand the nature of her constipation problem and participate fully in the management. The treatment is mainly conservative with diet, biofeedback and physiotherapy as the cornerstones of management. A multidisciplinary team approach will help for successful management of the patient. Surgery is normally not necessary for these patients and is only performed in extremely difficult refractory cases. By taking the time to make the correct diagnosis, patients with PFD can avoid frustration, unnecessary testing and surgery.

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Background: Hookah smoking has been increasing in the past few years in the United Arab Emirates (UAE) and becoming a public health concern. The objective of the study was to assess the knowledge, practices and reasons of hookah smoking among UAE residents. Methods: A cross-sectional study design used a structured and validated self-administered survey. Results: Out of 420 individuals who participated in the study, 54.5% (n = 229) were males. The prevalence of smoking hookah was 37.7% (n = 158) and more prevalent among people aged 18–29 years (n = 99, 41.6%), Arab non Emiratis (n = 112, 42.6%) and cigarette smokers (n = 54, 49.1%), P < 0.05. The most common reasons for hookah smoking were enjoyment (n = 107, 67.7%), friends' influence (n = 99, 61.4%, n) and as an aid of stress relief (n = 41, 25.9%). Hookah smoking was more likely to be in cafés (n = 127, 80.4%), with friends (n = 140, 88.6%). Compared to smoking cigarettes, only 23% (n = 97) of the participants thought that smoking hookah is more likely to cause addiction and 46.4% (n = 157) thought that hookah contains more nicotine. Conclusion: enjoyment and friends' influence were the most common reasons for hookah smoking and cafes and restaurants were the most common places to share this practice. Hookah smoking was prevalent among young adults with poor knowledge of harms and a huge number of misconceptions, solidifying the need for health education and enforced implementations of laws to limit hookah smoking.

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Background: Prostate cancer (PC) is recognised as the leading cancer diagnosis in Canadian men and the third-highest cause of cancer mortality. Despite its prevalence increasing with age, in Canada, funding for PC research is much lower when compared to other forms of cancer. Androgenic alopecia (AA) is a medical condition known to affect more than a third of all men and women. Studies show that AA is a medical condition with significant physical and psychological harms to the patient but one that can be treated effectively by a general practitioner. Objective: The objective is to determine the possibility of using finasteride to concurrently treat AA and prevent PC for men with more than one PC risk factor, one of which being AA. Methods: Numerous databases were searched, including OVID, Cochrane, Medline and PubMed. Additional internet searches were done using keywords such as dihydrotestosterone (DHT), AA, male pattern baldness, prostate-specific antigen, PC and finasteride, including a Medical Subject Headings search combining these words. Results and Conclusion: As a risk indicator for a PC diagnosis, early recognition of AA is important. Considering AA in conjunction with other risk factors for PC provides a more accurate risk assessment for patients. Finasteride has been shown to be effective in treating AA. By reducing DHT, a determining factor of both AA and PC development, finasteride has been demonstrated to reduce the risk of PC development by 25%. Finasteride therapy is an effective, low-risk, AA treatment option with the benefit of protecting potentially more susceptible men from PC. Given its excellent safety profile, as demonstrated in long-term studies of benign prostatic hyperplasia treatment, finasteride should be offered routinely to men with AA.

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Background: Acute pancreatitis is a common gastrointestinal disease and timely severity stratification is crucial in reducing the mortality and morbidity of the patients. Many markers have been studied for their role as a single predictor of the severity of the disease. Our study is aimed to evaluate the performance of C-reactive protein (CRP) testing as a single biomarker in predicting the severity of acute pancreatitis. Methods: Retrospective observational study with data collection and content analysis design. Patients were divided according to the acute physiology and chronic health evaluation (APACHE II) score into two categories, mild and severe. CRP testing was obtained within 48 h of hospital admission. Results: Our results showed that out of 99 patients, 82 patients had a mild attack of acute pancreatitis, while 17 patients had a severe form of the disease. The mean CRP level of patients with severe acute pancreatitis was significantly higher than the mean CRP level of patients with the mild form of the disease. There was a fair agreement between CRP level and the APACHE II score. Conclusion: C-reactive protein (CRP) test obtained within 48 hours of hospital admission is a helpful tool in predicting the severity of acute pancreatitis.

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Background: Dengue fever (DF) is an arboviral disease of public importance with high mortality and morbidity in tropics. The school-going children are at high risk of developing dengue as they are exposed to the vector, female Aedes aegypticus mosquito, during daytime. The paediatric patients may not present with typical symptoms like in adults. Aim: The aim of this study is to study the clinical and laboratory parameters in paediatric patients with emphasis on various haematological ratios. Materials and Methods: This was a retrospective study conducted in the Clinical Microbiology Department of Tertiary Care Hospital in the coastal part of Karnataka, India, to compare the clinichaematological parameters in the paediatric patients diagnosed with DF. The data were retrospectively collected from January 2015 to December 2018 entered into Microsoft excel, and statistical analysis was done by the Student's t-test. P < 0.05 was considered statistically significant. Results: A total of 258 patients were included in the study, with 132 (51.4%) were females and 112 (43.2%) patients belonging to 11–15 years' age group. The most common symptoms were fever (100%), vomiting (36%) and headache (21.6%). The dengue patients had leucopenia, lymphocytosis, monocytosis, thrombocytopenia, increased erythrocyte sedimentation rate and haematocrit were elevated significantly. The aspartate transaminase and serum creatinine were increased. Conclusion: When a patient presents with fever, vomiting, headache, thrombocytopenia and increased haematocrit may be indicator to DF in endemic areas.

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Background: Flexor tenosynovitis is a frequent cause of hand pain in diabetic patients, and corticosteroid (CS) injection is usually efficiently used in the treatment protocol. Ultrasound (US) guidance is usually helpful for accurate needle placement and improves the outcome. Aim of the Work: The aim of the work was to evaluate the efficacy of US-guided injections compared to clinically guided injections, the treatment of flexor tenosynovitis in diabetic hands. Patients and Methods: Patients were divided into two matched groups of diabetic patients with flexor tenosynovitis: Group 1 – treated with local CS injection under US guidance and Group 2: treated with local CS injection under clinical guidance. Both the groups were assessed twice for pain and tenderness using visual analog scale (VAS) and Richie index, respectively, one before the injection and the second 1 month after. All affected tendons were assessed and graded by US and power Doppler at baseline and 1 month after the injection. Results: Both the groups were matched as regards the disease duration, age, and glycated hemoglobin A1c. The mean VAS for Group 1 was 8.1 ± 0.8 cm at baseline and 3.4 ± 0.7 cm in the second visit; greyscale US showed improvement in 16 patients (61%). The mean VAS was 8.3 ± 0.7 cm at visit one, while it dropped down to 4.5 ± 0.9 cm in visit two. Conclusion: US-guided injections of CSs are statistically superior to clinically guided in treating flexor tenosynovitis in diabetic patients.

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Obstructive sleep apnoea is a common disorder that is often underdiagnosed and undertreated in healthcare services. It is defined as a condition in which breathing stops involuntarily for brief periods during sleep. It has many potential adverse consequences such as decreased daytime function with excessive daytime sleepiness, upsurge in work/road incidents and an increased risk of cardiovascular morbidity and mortality.

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Numerous publications on stem cells (SC) and cell therapies have appeared recently. Topics discussed in the literature include the differentiation of exogenous SC into various cell lineages, replacement of senescent and dysfunctional and damaged cells. However, in vitro differentiation with the expression of certain markers does not prove the replacement of functioning cells in vivo. The application of cell therapies in cardiovascular, hepatic, neurodegenerative diseases, osteoarthritis and diabetes mellitus is discussed in this article. Some publications tend to exaggerate successes of cell therapies without giving due consideration to adverse effects. In recent years, there has been a global expansion of stem cell treatments with unproven efficiency. In conclusion, therapeutic methods with unproven effects should be applied within the framework of high-quality research shielded from the conflicts of interest.

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Background: Tobacco consumption causes serious health ill-effects to human beings. Cancer and cardiovascular-related defects are more common in personal smoking. Aim & Objective: The focal aim of the present study is genetic changes in smoking subjects based on their age and exposed years. Materials and Methods: Based on the current study 80 subjects are selected from Dharmapuri district, Tamil Nadu. Fringe venous blood was gathered from both the control and the exploratory subject. Results: Increased levels of chromosomal aberration (CA) and Micronucleus (MN) are seen in heavy smokers contrasted with non-smokers separately. Both lower and light smokers indicated essentially expanded ca frequencies than control. MN indicated an expanded level of variations from the norm in smokers (light, medium, and weighty than non-smokers). Conclusion: The frequencies of MN in blood lymphocytes are high in smokers especially the heavy smoker's group demonstrated significantly increased level of genetic abnormalities.

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Warfarin is a common drug used in treating patients with deep-vein thrombosis, pulmonary embolism and other conditions. One of its adverse effects is warfarin-induced skin necrosis (WISN) which is a rare complication and accounts for 0.01%–0.1% of patients who received the drug. We are reporting a 60-year-old diabetic male presented to the emergency room complaining of right leg pain and swelling. On examination, the calf muscles were tender, indurated and swelled. Laboratory tests showed elevated D-dimer. Duplex ultrasound revealed a thrombus in the popliteal and tibial veins. Heparin was started and warfarin was added after 3 days. On the next day of warfarin overlap, the whole leg and ankle become dusky blue in colour. WISN is suspected and thus warfarin is stopped, after which the patient's skin gradually improved. We are assuming that improper overlap of heparin in this case resulted in such a condition.

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Dysphagia lusoria is a difficulty in swallowing caused by the impingement of an aberrant vessel on the oesophagus. This case study presents a 90-year-old patient who had persistent dysphagia caused by aneurysmal dilatation of the right aberrant subclavian artery.

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We report a case of cryptococcal meningitis in a 48-year-old woman with underlying mixed connective tissue disease. She presented with multiple joint pains and low-grade fever for 3 months, headache for 1 month and weakness of all four limbs for 15 days. The neck was stiff, and Kernig's sign was positive. The cerebrospinal fluid cryptococcal antigen test was positive. Autoimmune profile revealed positive antinuclear and U1 ribonucleoprotein antibodies. Magnetic resonance imaging of the brain showed T2/fluid-attenuated inversion recovery hyperintensity in the midbrain and upper pons. The patient gradually improved on antifungal therapy.

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