Bilateral hydroureteronephrosis involves the dilatation of the renal pelvis, calyces and ureter; it develops secondary to urinary tract obstruction and leads to a build-up of back pressure in the urinary tract, and it may lead to impairment of renal function and ultimately culminate in renal failure. Although clinically silent in most cases, it can be diagnosed as an incidental finding during evaluation of an unrelated cause. In a minority of patients, it presents with signs and symptoms. Renal calculus is the most common cause, but there are multiple non-calculus aetiologies, and they depend on age and sex. Pelviureteric junction obstruction, benign prostatic hypertrophy, urethral stricture, neurogenic bladder, retroperitoneal mass and bladder outlet obstruction are some of the frequent causes of hydroureteronephrosis in adults. The incidence of non-calculus hydronephrosis is more common in males than in females. Ultrasonography is the most important baseline investigation in the evaluation of patients with hydronephrosis. Here, we report a rarely seen case of bilateral hydroureteronephrosis associated with a hypertrophied, trabeculated bladder in an adult male cadaver, suspected to be due to a primary bladder neck obstruction, and analyse its various other causes, clinical presentations and outcomes.

Falls is a global health concern due to its many negative consequences in older adults. Early falls screening and prevention is important among older adults. We developed Falls Screening Mobile Application (FallSA) as a self falls screening tool among older adults. FallSA was developed using data of physical performance test, demographic information and questions to inform falls risk from a larger population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). The aim of this study was to determine validity and reliability of FallSA as a self-screening tool to inform falls risk among Malaysian older adults. This cross sectional study was conducted among 91 community dwelling older adults aged 60 years and above. FallSA was validated against Physiological Profile Assessments (PPA), a comprehensive falls risk assessment tool. Participants used FallSA to test their falls risk by repeating the test twice between an hour. Validity and test–retest reliability of FallSA was examined by using Spearman correlation, Kappa, Sensitivity and Specificity, Intra correlation coefficient (ICC), Cronbach alpha and Bland-Altman respectively. Concurrent validity test was significant with moderate correlation rs = 0.518, p < 0.001, moderate agreement K = 0.516, p < 0.001 and acceptable Sensitivity: 80.4% and Specificity: 71.1%. Reliability of FallSA was shown to be good (ICC: 0.948, CI: 0.921-0.966), good internal consistency α = 0.948, p < 0.001 and good agreement indicate by small mean differences and narrow limits of agreement (LoA). The results of this study suggest that FallSA was a valid and reliable tool to inform falls risk among Malaysian older adults. Further prospective studies are required to determine the accuracy of FallSA to correctly classify older adults into fallers and non-faller groups.

Two different salts of diclofenac, diclofenac sodium and dielofenae potassium, in tablet dosage form were tested for their bioavailability and disposition kinetics in a group of eighteen rabbits in normal and experimentally induced dehydrated conditions with a wash out period of 7 days between both stages of study. Biochemical and physiological parameters were also measured in both normal and dehydrated states. Diclofenac levels in plasma were determined using a validated reversed phase HPLC method. Primary kinetic parameters i.e. AUC0-∞, Cmax, Tmax and other disposition kinetics were obtained with non-compartmental procedure. Biochemical parameters i.e. packed cell volume, plasma glucose and total lipid concentration in dehydrated rabbits increased significantly. Plasma concentration of diclofenac sodium and diclofenac potassium decreased significantly in water deprived rabbits. In comparison, diclofenac potassium in normal and dehydrated state of the same group of rabbits showed a significantly increased plasma concentration when compared with diclofenac sodium.

Background: Headache disorders represent a major public health problem globally. It is more so in developing countries with rising trend in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in Kashmir India which has witnessed prolonged and large scale militancy related disturbance. A prospective population based study was undertaken in Srinagar district of Kashmir to determine the prevalence of headache disorder. Methods: The study was a cross sectional survey using cluster sampling with a culturally adapted version of pretested questionnaire translated into local language, in Hazratbal Community Block of Srinagar. In the first phase households were screened. Individuals with headache were then examined by a senior neurologist for migraine and non migraine disorder. Results: The overall prevalence of headache was 66.2 % with female preponderance. Occurrence of headache was as high as 79.90 % in adults of 19-45 years. The prevalence rate declined after the age of 45 years in both the genders. Women had higher prevalence rate than men in all age groups and for all headache categories. Age distribution showed prevalence rate of migraine of 45.69% in young adults of 19-45 years; females 55.44% and males 32.79 %. Non migraine headache was more common than migraine type, and was more prevalent in young age group in both the genders, highest in adolescents (74.20 %). Conclusion: The high prevalence rate of headache both migrainous and non migrainous in Kashmir may be related to the stress the community has been subjected to from militancy related conflict since 1990.
Headaches

Objectives: Anxiety and depression among doctors may negatively affect quality of patient care, patient safety, and professionalism. Despite the potentially serious personal and professional consequences of depression, there are very limited researches done on depression among Pakistani doctors. Therefore this study was aimed to determine the prevalence of anxiety and depression among doctors in a private teaching hospital in Pakistan. Method: This was a cross-sectional survey conducted in a tertiary care teaching hospital in Pakistan. The Self-Reporting Questionnaire for Anxiety and Depression (SRQ 20) Scale was administered to a sample of 300 medical doctors. Chi-square test and multiple regressions were used for data analysis. Results: Anxiety and Depression among doctors was measured to be 27.3 % (95% CI: 22.3, 32.4) in our study. Conclusion: More than one quarter of our doctors are suffering from anxiety and depression but this subject is fairly neglected in Pakistan and more studies should be conducted to collect more validated information on this matter.

Falls are major public health issues which highly associated with older adults worldwide. Falls can cause a negative debilitating effect on the individual and may lead to fatal injury in certain cases. Current studies on falls characteristics are limited in Malaysia. The aim of this study was to pool the current studies conducted in Malaysia regarding the fall and its characteristics. Articles were identified by using the following electronic databases; EBSCOhost, ClinicalKey, ScienceDirect, Wiley Online Library, SpringerLink and Google Scholar. Article identification was limited to English language which were published between 2013 to 2019. This study looked into older adults aged 60 years old and above; conducted either in a residential, community-dwelling or medical institute. A total of nine articles was identified and investigated. Studies indicate a huge variation in the prevalence falls among older adults in Malaysia ranging between 4-74%. A study that was conducted in the community indicated lower prevalence of falls. Majority of the falls occurred in the morning as reported by three studies which covered and ranged between 49-64.7%. Indoor accounted as the highest number of falls in term of location and ranged between 50-87% while outdoor falls were between 13-49.3%. Location in bathroom and toilet had the highest percentage of indoor falls. Fallers that sustained injury ranged between 47-82%. A variation on the fall prevalence among older adults was determined by factors such as location and existing medical conditions. Pooled information in our study indicates that there is lack of standardised measuring tools for falls characteristics in Malaysia. There is a need for large scale longitudinal prospective study to establish the prevalence and the causal-effect relationship of falls in Malaysia.

Congenital cholesteatoma (CC) is rare clinical condition and It is known as a pearly white mass medial to an intact tympanic membrane. In this case report, we describe a 6-year-old boy who presented with a one year history of left ear discomfort, reduced hearing, followed by ear discharge two months prior to admission. Otoscopic examination revealed a large attic perforation. Radiological investigation showed extensive cholesteatoma in the mastoid, mesotympanum and epitympanum with destruction of the ossicles including the stapes footplate. He underwent radical mastoidectomy in view of extensive cholesteatoma with tympanoplasty type V. In this case report, the classification, treatment and theories related to CC are discussed.

We report a 40 year old woman admitted with an acute abdomen. Investigations revealed pancreatitis, bilateral pleural effusion, renal failure, disseminated intravascular coagulation, and scrub IgM ELISA and dengue NS1 positivity. She improved with azithromycin and appropriate pain and fluid management. She also developed central venous catheter-related MRSA sepsis that was managed in the hospital.

Six compounds have been isolated from the leaves of Pyrenacantha staudtii,two of which are new compounds.The new compounds have been characterized as kaempherol 3-O-β-rhamnopyranosyl (1→6)β-D-glucopyranoside (1) and 4-β-glucopyranosyl-(2-furyl)-5-methy-1,2-glucopyranoside phenylmethanone (2).The known compounds are 3-pyridinecarboxylic acid (3),β-sitosterol (4),sitosterol 3-O-β-glucopyranoside (5) and taraxerol (6).Their structures were determined by spectroscopic and chemical evidences.The two new compounds together with 3-pyridinecarboxylic acid showed significant in vitro xanthine oxidase inhibitory activity.To the best of our knowledge,this is the first report of these compounds from this plant.

Aims: Pseudoalteromonas ruthenica KLPp3 is the marine Gram-negative strain isolated from the surface of mud crab at Pulau Perhentian Malaysia. In this work, the anti-biofilm activity of P. ruthenica supernatant was examined on Serratia marcescen and Vibrio alginolyticus. Methodology and results: The crude extract of P. ruthenica KLPp3 was obtained using ethyl acetate. The subminimum inhibitory concentration (MIC) of the crude extract was determined using the minimum inhibitory test. The subMIC crude extract was tested against two of the S. marcescen virulence factors, which are the swarming ability and production of prodigiosin. The crystal violet assay was used to test the anti-biofilm activity of the sub-MIC crude extract against S. marcescen and V. alginolyticus. The productions of prodigiosin were reduced by 72%. The swarming area was reduced by 56.06%. It inhibits 26.9% and 48.5% of biofilm production in S. marcescens and V. alginolyticus respectively. The crude extract was heat stable. Conclusion, significance and impact of study: Besides combating the S. marcescens virulence factor, P. ruthenica KLPp3 crude extract in sub-MIC reduces the formation of biofilm of S. marcescens and V. alginolyticus, which may find applications in biofilm inhibition and prevention.
Anti-Infective Agents