Breast cancer remains the most common cancer in many parts of the world, particularly for women. In March 2015, a Breast Oncology clinic for breast cancer patients was established at Mankweng Hospital. Invasive ductal carcinoma is the most common (87 %) tumour found in Limpopo, and occasionally, another rare tumour of the breast is presented in the Breast Oncology clinic. The aim: The main objective is to share the experience of a rare tumour of the breast came across over the past 8 years since the establishment of the Breast Oncology clinic. Material and Method: Series of rare case reports of Breast tumours and literature review from the Mankweng Breast Oncology Clinic. Result: Rare tumour encountered in Breast Oncology clinic: adenomyoepithelioma, micro-papillary carcinoma of the breast, primary malignant melanoma of the breast, primary non-Hodgkin's lymphoma of the bilateral breast, advanced breast cancer in a case of Down's syndrome, primary neuroendocrine invasive breast carcinoma, sarcoma of the breast. Conclusions: Most of these rare cases are presented to the Breast Oncology clinic in the advanced stage. Breast cancer awareness campaign is highly important for women in Limpopo, particularly when attending primary health care for any other conditions.

Spindle cell carcinoma of the breast is a rare breast malignancy, and it accounts for <1 % of breast neoplasms. Tumours are usually large, well-circumscribed, and cystic-containing lesions in the upper outer quadrant of the breast. The aim: The main objective of the case report is to highlight our experience with Spindle cell carcinoma of the breast. Result: A case presentation of a 58-year-old female who was referred from the peripheral hospital to our breast oncology clinic with a left breast mass rapidly growing for the past five months. The mass measured 23cm x 20 cm, palpable in all quadrants of the breast but more in the upper outer quadrant of the breast. Mammography and ultrasound showed a massive heterogeneous left breast solid mass involving the entire breast and all quadrants, with areas of cystic components and increased flow. There were no calcifications noted. She was assessed as BI-RAD 5. A core needle biopsy showed spindle cell carcinoma of the left breast. The patient was offered a modified radical mastectomy. Conclusion: Spindle cell carcinoma of the breast poses a diagnostic challenge due to the rarity of the disease; overlapping morphological features on histology and biomarkers specific to spindle cells have not been extensively studied

Type 2 diabetes mellitus (T2DM) is associated today with a non-infectious epidemic. Every year, the number of people suffering from this disease only increases. The comorbidity of pathology, namely gastroesophageal reflux disease (GERD) against the background of type 2 diabetes mellitus, is increasingly observed. Pathogenetic mechanisms of the progression of the latter in the combined course with type 2 DM are not sufficiently studied today, and data on the effect of adipokines on the morphological pattern of the esophagus in patients with type 2 DM are emerging. The aim of this study is to study changes in the esophageal mucosa depending on the concentration of ghrelin and leptin in patients with comorbid GERD on the background of type 2 diabetes. Materials and methods of the research. 120 patients were recruited for the study and divided into 3 groups and a control group. The 1st group – 60 patients with a combined course of GERD and type 2 DM, the 2nd group – 20 patients with GERD, and the 3rd group – 20 patients with isolated type 2 DM. The control group - 20 practically healthy people of the appropriate age. The levels of ghrelin and leptin were determined by enzyme-linked immunosorbent assay (ELISA) on a Labline-90 analyzer (Austria). Endoscopic examination of the upper parts of the gastrointestinal tract (GI) with targeted biopsy was performed with an esophagogastroduodenoscope with end optics "Olympus GIF Q 150-03" (manufactured by Olympus Europa SE & CO. KG, Japan). The degree of complexity and the presence of reflux esophagitis were determined according to the Los Angeles classification and grading system of esophagitis of the Japanese Society of Esophagitis (JSDE), modified in 1999 [1]. Results. Correlation analysis of the relationship between ghrelin and leptin indicators showed a reliable, inverse, medium strength dependence (r = -0.5531; p<0.05). Reliable maximum values of ghrelin were found in patients with non-erosive form of GERD, and minimum values of ghrelin were recorded in patients with reflux esophagitis stage C. When studying leptin indicators depending on the degree of esophagitis, the following data were obtained: the maximum values of leptin were found in patients with reflux - stage B esophagitis, and minimal - in patients with a non-erosive form of GERD. Regarding the reliability of the obtained data on leptin concentration, we did not find statistically significant differences in the studied groups (p>0.05). Conclusions. According to the results of the conducted research, we can say that changes in the concentration of ghrelin have an important diagnostic value in the focus of GERD against the background of type 2 diabetes. Decreased ghrelin levels have been associated with erosive forms of GERD in the setting of type 2 diabetes, which can lead to a significant deterioration in the patient's lifestyle. According to the data obtained during the study on the influence of leptin levels on changes in the mucous membrane of the esophagus, it was found that morphological changes in the esophagus did not depend on the concentration of leptin in the studied groups

Skin diseases are a common and inevitable consequence of ageing. Moreover, the clinical presentation is not as classical as they do in the younger population. A lifetime of solar exposure, along with intrinsic changes in the dermal structures, predisposes to a variety of skin diseases. The aim: to study the spectrum of various geriatric dermatoses among our patient population at the Department of Dermatology, Venereology, and Leprosy at Kamineni Academy of Medical Sciences and Research Centre. Materials and methods: in this study, a total of 200 patients aged 60 years and above attending the DVL OPD of Kamineni Academy of Medical Sciences and Research Centre were included. Results: maximum number of patients in this study belonged to 60-65 years (60 %), Male to female ratio was 1.86:1. Most of the males had agriculture work, and most of the females were housewives. Diabetes mellitus was the commonest associated systemic disease seen in 68 cases (34 %), and generalised pruritus was the commonest symptom seen in 64 (32 %) cases, of which 42 cases (65.6 %) were associated with xerosis. Pathological skin disorders and eczematous conditions were seen in 56 out of 200 cases. Of this, asteatotic eczema was the common finding among the eczematous conditions seen in 14 cases (7 %). Psoriasis was seen in 32 (16 %) and lichen planus in 10 cases (5 %). Infectious diseases were seen in 78 cases (39 %). Of these, fungal infections were common, seen in 28 cases (14 %). The benign tumour was seborrheic keratosis in this study, seen in 61 cases (30.5 %); among the malignant tumours, 4 cases (2 %) of basal cell carcinoma and 2 cases (1 %) of squamous cell carcinoma were seen. Among 16 cases of bullous disorders, bullous pemphigoid was seen in 12 (6 %) cases. Among 22 cases of psychocutaneous disorders, delusional parasitosis was seen in 10 cases (5 %), and perforating folliculitis in 15 cases (7.5 %). Loss of luster was the commonest nail change seen in 182 cases (91 %), followed by nail plate thickening in 54 cases (27 %). Greying of the hair was seen in all cases. Out of 70 females, diffuse hair loss was seen in 58 cases (82.9 %), and out of 130 males, androgenetic alopecia was seen in 72 cases (55.4 %). Conclusion: skin diseases cause considerable morbidity in the elderly, particularly if associated with other comorbid conditions. Health education on proper skin care, avoidance of irritants and self-medication etc., would help to reduce the incidence of common dermatoses.

Respiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. The aim: The study is intended to evaluate the importance of giving antenatal corticosteroids in decreasing respiratory distress syndrome in preterm neonates. Materials and methods: Prospective cohort study done in all preterms delivered in the hospital attached to those admitted in our neonatal intensive care unit during the study duration are taken as the source. All preterm babies are admitted to the neonatal intensive care unit. Results: The overall incidence of RDS in this study was 30 (15 %), among which 7 (7 %) were exposed to steroids, and 23 (23 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of RDS in preterms (neonates born between 28–37 weeks of gestational age). The overall incidence of TTN (transient tachypnea) was found to be 46 (28 %) in this study, among which 14 (14 %) were exposed to steroids, and 32 (32 %) were not exposed to steroids. Antenatal corticosteroids were significantly associated with reduced incidence of TTN in preterms. Antenatal corticosteroids significantly reduce the need for supplemental oxygen, NICU admission, need for CPAP and mortality rate. The dose of antenatal corticosteroids was significantly associated with the incidence of RDS and TTN. 2 doses of steroids reduced RDS and TTN significantly compared to the single dose, which was just significantly associated. This study found no significance between RDS and TTN with gestational age, mode of delivery, birth weight and RDS among steroid-exposed babies. Conclusion: The use of antenatal corticosteroids should be promoted because they successfully lowered morbidity and mortality among premature newborns in the population studied. In order to optimise proper and timely prenatal corticosteroid treatment, this study underlines the necessity for quality improvement initiatives.

The aim: The study aimed to determine the prevalence of several non-communicable diseases (NCD) and analyze risk factors among adult patients seeking nutritional guidance in Dhaka, Bangladesh. Participants: 146 hospitalized adults of both genders aged 18-93 participated in this cross-sectional research. Methods: We collected the demographic and vital information from 146 hospitalized patients in Dhaka, Bangladesh. We checked the physical and vital parameters, including blood sugar, serum creatinine, blood pressure, and the presence or absence of major non-communicable diseases. Then we used descriptive statistical approaches to explore the NCDs prevalence based on gender and age group. Afterwards, the relationship between different NCD pairs with their combined effects was analyzed using different hypothesis testing at a 95 % confidence level. Finally, the random forest and XGBoost machine learning algorithms are used to predict the comorbidity among the patients with the underlying responsible factors. Result: Our study observed the relationships between gender, age groups, obesity, and NCDs (DM, CKD, IBS, CVD, CRD, thyroid). The most frequently reported NCD was cardiovascular issues (CVD), which was present in 83.56 % of all participants. CVD was more common in male participants. Consequently, male participants had a higher blood pressure distribution than females. Diabetes mellitus (DM), on the other hand, did not have a gender-based inclination. Both CVD and DM had an age-based progression. Our study showed that chronic respiratory illness was more frequent in middle-aged participants than in younger or elderly individuals. Based on the data, every one in five hospitalized patients was obese. We analyzed the comorbidities and found that 31.5 % of the population has only one NCD, 30.1 % has two NCDs, and 38.3 % has more than two NCDs. Besides, 86.25 % of all diabetic patients had cardiovascular issues. All thyroid patients in our study had CVD. Using a t-test, we found a relationship between CKD and thyroid (p-value 0.061). Males under 35 years have a statistically significant relationship between thyroid and chronic respiratory diseases (p-value 0.018). We also found an association between DM and CKD among patients over 65 (p-value 0.038). Moreover, there has been a statistically significant relationship between CKD and Thyroid (P<0.05) for those below 35 and 35-65. We used a two-way ANOVA test to find the statistically significant interaction of heart issues and chronic respiratory illness in combination with diabetes. The combination of DM and RTI also affected CKD in male patients over 65 years old. Among machine learning algorithms, XGBoost produced the highest accuracy, 69.7 %, in comorbidity detection. Random forest feature importance detected age, weight and waist-hip ratio as the major risk factors behind the comorbidity. Conclusion: The prevalence study helps to identify the future risks and most vulnerable groups. By initiating and implementing control plans based on the prevalence study, it is possible to reduce the burden of NCDs on the elderly and middle-aged population of Bangladesh.

The aim: To study the correlation between severe oligohydramnios with perinatal outcome and the placenta's histopathology. Materials and methods: comprised of 100 patients with oligohydramnios diagnosed after 28 weeks of gestation, admitted on an emergency basis, both booked / unbooked, who were willing to cooperate, were chosen. All patients with oligohydramnios (AFI<5 %) were included in the study. Results: 3 cases came with intra-uterine death. All three were totally unbooked cases. 2 preterm babies died neonatal intensive care unit after 4 days due to meconium aspiration syndrome. Thus the perinatal mortality was 5 %. 44 % of neonates required admission into the neonatal intensive care unit. In our study, it was found that neonatal mortality and morbidity increased significantly when oligohydramnios was associated with complications like IUGR and pregnancy-induced hypertension in mothers. All the cases associated with these histopathological changes had adverse perinatal outcomes. Hence estimation of the amount of liquor is important in the antenatal period because oligohydramnios gives insight into the associated maternal complications or fetal anomalies and has a significant bearing on the perinatal outcome. The placental examination will illuminate all the conditions affecting the perinatal outcome. Without associated complications, oligohydramnios does not have adverse perinatal outcomes. Conclusions: Thus, in cases of oligohydramnios with no associated complications, expectant management can be tried for a better fetal outcome. Only oligohydramnios may be the first sign of placental insufficiency and an independent manifestation of the placental-related complications spectrum.

The aim: to summarize the methodology of prenatal gender selection and the ethical aspects of its implementation.
 Materials and methods: the authors conducted the review in the database of scientific periodicals PubMed.
 Results: based on scientific publications, the principal techniques to determine sex in the pre-implantation period, in the embryo and fetus, are presented. Invasive and non-invasive procedures of prenatal diagnosis are described. Invasive procedures include examination of the fetus by chorionic villus sampling karyotyping of cells obtained by amniocentesis. Non-invasive techniques related to pregnant women's blood biochemistry and ultrasound markers of Down syndrome are given. Fetal blood DNA testing is a more sensitive diagnostic parameter that reduces the indication for invasive procedures. The newest and most effective method of sex determination in the pre-implantation period is sperm separation screening. Medical and non-medical reasons for prenatal gender determination, such as prevention of X-linked genetic disorders in a child, a couple's choice to balance the sex of children in the family and social gender preferences are shown. Gender selection for the prevention of X-linked disorders is justified. Ethical issues regarding the balance of children in the family, giving preference to certain sex with the help of advanced diagnostic techniques, and selective abortion are discussed. The bioethical principles for preventing selective abortion resulting from gender reasons are established.
 Conclusion: for preventing prenatal gender discrimination is highlighted more strongly by the need legal regulation and the ethical control of scientific technologies in reproductive medicine.

Dentists are on the frontline of infection, especially regarding respiratory viruses like the new coronavirus. The production of aerosols and droplets accompanies many dental procedures. The emergence of severe acute air-droplet disease, respiratory syndrome, or SARS, warrants a revision of the infection control procedures for aerosols. The aim. In this article, we aim to raise awareness of the potential risks of COVID-19 transmission in dental practice and discuss and suggest some preventive measures. Methods. This study reviewed the published research articles and the guidelines of international healthcare institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. Results. The main way of transmission of the SARS CoV is air-droplet. Thus, healthcare professionals that perform aerosol-generating procedures, i.e. dentists, need to be updated about the origin of the disease. The patient and the dentist often share close contact while ongoing dental treatment; thus, knowledge about the disease and necessary preventive measures is required. In addition to the standard precautions, some special preventive measures that should be implemented during an outbreak of disease have been raised in this review. Conclusions. Following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting

The clinical spectrum of Cerebral palsy (CP) can differ in various places depending upon the knowledge of the people and resources for prevention, diagnosis and management. Although studied extensively in high-resource countries, adequate data related to CP from resource-constraint settings are lacking. The aim: The present study is a descriptive study done on clinical profiles, aetiology, and comorbidities. Materials and methods: Present study is a hospital-based descriptive study of 80 children with Cerebral Palsy from January 2020 to June 2021 (18 months) admitted to Niloufer Hospital for Child Health, cases chosen as per inclusion criteria guided by "The Definition and classification of cerebral palsy, April 2006 International consensus". Clinical history and clinical examination and necessary investigations using a systematically designed proforma Results: The most common types were spastic type (78.9 %) and hypotonic type (12.5 %). Spastic quadriparesis (55 %) was the most common among subtypes. Males were more affected than females, with more rural than urban distribution. 48.8 % belonged to the lower middle and 37.5 % to the upper lower class of socio-economic status. Consanguinity was observed in 33 %, and 3 % had a similar family history. A high incidence (65 %) was seen in firstborn children. Term gestation was commonest at 87 % and prematurity at 13 %. 91.3 % of the cases were institutional deliveries. For causes of cerebral palsy, 45 % required resuscitation at birth, 2.5 % had neonatal sepsis, 1.25 % had a cerebral malformation, 7.5 % had an intracranial bleed, 7.5 % had post-meaning encephalitic sequelae, 1.3 % had TORCH infection. Comorbidities Like mental retardation were seen in 90 %, seizure disorder in 87.5 %, visual problems in 24.8 %, hearing problems in 13.75 %, 56.25 % of cases were malnourished. Conclusions: Comorbidities are significantly observed in cases of cerebral palsy. Appropriate screening and management of comorbidities, especially vision, hearing, speech, seizures, and nutrition, improve the overall prognosis in cases of Cerebral palsy.