Background: Post-operative blood loss remains a major problem after cardiopulmonary bypass. A common complication after Coronary Artery Bypass Grafting (CABG) is postoperative bleeding, which is considered as an important problem. Objective: The aim of this study is to study only patients who have never used drugs above so that it can assess postoperative bleeding in CABG with the absence of high-risk medications related to postoperative bleeding. Methods: This cross sectional study was carried out at the Department Of Cardiac Surgery in Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2019 to December 2019. 50 patients who were candidates for CABG surgery participated in the study. Inclusions criteria included who were candidates for CABG surgery, avoiding the use of blood clotting drugs before surgery, avoiding the use of immunosuppressant, and the absence of an underlying medical condition such as kidney diseases. Patients with inflammatory, platelet diseases, or any coagulation disorder were excluded. All patients initially tested for hemoglobin, platelets and hemoglobin and International Normalized Ratio (INR). In addition to testing for hemoglobin, the amount of bleeding and packed red cell; frozen plasma and platelets were recorded. Results: Fifty patients who were candidates for elective surgery, including 33 men (66%) and 17 women (34%) were enrolled in this study. The mean patient age was 8.70+57.9years old. Test showed that mean hemoglobin level of patients before surgery was pre-operative of 1.5+12.4 g/dL, mean platelet was equal to 54.14+250.8 thousand/ μL and an average international normalized ratio (INR) was equal to 0.12+1.07. The results after surgery also showed that: The total units of given packed red cell; frozen plasma and platelets were (3.14+1.90; 2.34+2.36 and 0.06 +0.42). Also, postoperative hemoglobin was 1.30+10.30 g/dL, which significantly decreased compared to pre-operative hemoglobin. Bleeding in.....

Introduction: Alkaptonuria (AKU) is a rare autosomal recessive disorder result from a deficiency of homogentisate 1, 2 dioxygenase (HGD), and leading to the accumulation of homogentisic acid (HGA) in the tissue. The deposition of excess oxidized HGA in the connective tissues causes pigmentation (ochronosis) and degeneration of the joint (ochronotic arthropathy) and tendons (ochronotic tendinopathy). There is no effective therapy for this disorder a side of symptomatic treatment. Case: we report our 43-year-old male farmer, who presents with bilateral asynchronous spontaneous Achilles tendon rupture (5 months apart) with no history of trauma or drug use, nonspecific low back pain, and apparent black pigments in the sclera, with a positive family history of similar condition. Diagnosis: laboratory investigations revealed black urine upon long-standing. A blackish degenerative tendon found during the operation. In addition, the Intraoperative Histopathological study shows dark stains and fibrosis with presence of inflammatory cells consistent with Alkaptonuria. Interventions: debridement of the distal end of the tendon was done; repair was done with augmentation of repair by anchor suture to calcaneus. Outcomes: The patient recovered very well after the operation with the restoration of full activity.

The prevalence of overt and subclinical hypothyroidism (SCH) during pregnancy is reported to be 0.3-0.5% and 2-3% respectively. In about 5-18% of reproductive women, thyroid autoantibodies are present. Thyroid dysfunction (hypothyroidism, hyperthyroidism and autoimmune diseases) during pregnancy can lead to serious problems for both mother and baby. The multitude of adverse events associated with untreated thyroid disease during pregnancy leads to consider the potential benefits and costs of thyroid dysfunction testing before and during pregnancy. There is controversy over whether to treat subclinical thyroid dysfunction in pregnant women. This article reviews the most important studies associated with SCH and attempts to draw literature-based conclusions on the management of subclinical hypothyroidism in pregnancy.