Tocilizumab is a humanized monoclonal antibody that binds to IL-6 receptors, both the soluble receptor (sIL-6R) and the one located in the cell membrane. In this way it blocks the molecular complex of the receptor and prevents cytokine signaling. It is a drug which has recently been approved by the FDA, several studies recently carried out at international level (USA, Japan, Europe) have demonstrated the great efficacy of tocilizumab in the treatment of juvenile rheumatoid arthritis.

Invasive micropapillary variant of mucinous carcinoma breast is an under-recognized category which shares features of both pure mucinous carcinoma and invasive micropapillary carcinoma. Due to its greater propensity for nodal metastasis and angioinvasion, the prognosis in this subtype is worser than pure mucinous carcinoma breast. Here we report a case of invasive micropapillary variant of mucinous carcinoma breast in a 43-year-old female.

Invasive micropapillary variant of mucinous carcinoma breast is an under-recognized category which shares features of both pure mucinous carcinoma and invasive micropapillary carcinoma. Due to its greater propensity for nodal metastasis and angioinvasion, the prognosis in this subtype is worser than pure mucinous carcinoma breast. Here we report a case of invasive micropapillary variant of mucinous carcinoma breast in a 43-year-old female.

Background: Significant alterations in maternal lipid metabolism occur during pregnancy. gestational diabetes mellitus (GDM) is the most commonly seen metabolic disorder during pregnancy. The association between dyslipidemia and GDM is unclear. Methods: The study population was from pregnant women attending the antenatal clinic of Department of Obstetrics and Gynecology, Lok Nayak Hospital, Delhi. Ethical clearance was granted by the ethical committee of the institute. Patients who attended the clinic at or before 28 weeks of gestation and were willing to participate were included in the study and venous sample was taken for lipid profile in fasting state. Lipid levels were compared in GDM and non GDM patients. Findings: Total 936 patients were recruited in the study and out of these 64 patients were diagnosed as GDM. The mean values of total serum cholesterol, triglyceride (TG) and high-density lipoprotein (HDL) cholesterol were 194.89+35.96 mg/dl, 170.96+46.69 mg/dl and 50.1+7.16 mg/dl respectively in all pregnant patients. The levels of total serum cholesterol and triglycerides were significantly higher in patients with GDM than in patients without GDM (p<0.001), whereas the difference in HDL cholesterol was not significant between two groups. Interpretation: Triglyceride levels are raised in all pregnant patients. Total cholesterol and triglyceride levels a significantly raised in GDM patients in comparison to non GDM patients.

Objective: This study will analyze the effects of the most common substances in medical students and their impact on their academic performance. Method: 328 medical students were interviewed between April 2019 to March 2020 for this study. In this cross-sectional study, information regarding substance use habits among medical students was obtained through a survey. The information was obtained through a questionnaire that is made up of 6 pages with the following sections: Registration, consumption of alcohol, marijuana, cocaine, medication to improve academic performance and energy drinks. Results: The results in this investigation were the following: the use of alcohol showed that it has a low relevance in influencing the performance of the students (p=0.702), the use of marijuana showed that it has a low relevance in the performance (p= 0.527), the use of cocaine showed that it has a low relevance in influencing academic performance (p=0.560), the use of medications showed that they have a high relevance in influencing academic performance (p=0.001), the use of energy drinks showed that they have a low relevance in influencing the performance of medical students (p=0.346). Conclusions: The use of substances among university students has been increasing over the years, the importance of understanding this phenomenon and its repercussions on students can help prevent addictions, school dropouts and even deaths from overdoses, as described in various literatures.

Introduction. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by symmetrical erosive polyarthritis leading to progressive disability. It is more common in women, with a 3:1 ratio. Environmental risk factors are smoking, exposure to silica and textile dust. Materials and methods. Fifteen articles and three books on rheumatoid arthritis were chosen to identify the most accurate diagnostic methods and the most effective and innovative treatments. Discussion. Related autoantibodies, such as rheumatoid factors, anti-citrullinated antibodies and anti- caramylated antibodies can be found in serum long before the disease develops. The interaction between genetic and environmental factors causes a breakdown of immune tolerance and triggers systemic autoimmunity. It has been shown that the lungs, oral mucosa, and gastrointestinal tract are initial sites where the immune system can become activated and produce RA. Different imaging techniques are available for diagnosis: plain radiography, Doppler ultrasound, and magnetic resonance imaging. Doppler ultrasound was found to be more sensitive in identifying minimal synovitis and more sensitive than plain radiography in detecting joint erosions. As pharmacological treatment, it has been concluded that the first-line drug is methotrexate, as it relieves signs and symptoms, improves physical function, and prevents or slows the progression of joint damage. We also observed that NSAIDs help in the inflammatory and symptomatic control of RA. Conclusion. The quality of life of affected patients has been maintained thanks to the early detection of the disease, since there are several treatments (physical therapies, aerobic exercises, medications, etc.), which help to stop the evolution of this disease and thus allow the patient to lead a daily life.

The aim of this study was to examine the effect of social support, gender and years of immigration on immigrant’s depression. Researchers have shown that there is an impact on depression state depending on years of immigration. Also, research has shown that there are individual differences in terms of how the immigrants perceives the social support and the interaction that has in the quality of life. Interestingly was that important factor being the social support that perceived immigrants. The design of this study was a parametric correlation and multiple regression were used to examine the results. Three independent variables the first is social support which measure the total support and more specific family support, friends support and significant others support. The second is gender with two levels males or females. Third variable is years of immigration with two levels less 5 years or more 5 years. Dependent variable is depression scores. The participants will be asked to complete two tests. The first was Multidimensional Scale of Perceived Social Support has 12 items about social support on significant others, family and friends’ support. The second questionnaires were CES- D with 20 items about depression with the higher scores indicating the presence of more symptomatology. The number of participants was 124 by which 62they were male immigrants and 62 they were female immigrants. From the results of research, it was found that the years of immigration, the age of immigrants and significant others support associated with the presence of depression of immigrants. Theoretical contributions and future research directions are discussed in the concluding section of the paper.

Background: Acute hyperglycemia predicts adverse outcomes in patients with acute myocardial infarction (AMI), but it has a major disadvantage because the association is diminished in patients with diabetes mellitus (DM). Recent studies introduced a more accurate predictor, the glycemic gap (the difference between admission blood glucose and the estimated average glucose), that could anticipate adverse outcomes in patients with diabetes with AMI. Aims: This study aimed to determine the association between glycemic gap and clinical outcome in diabetic patients presenting with AMI to a tertiary hospital in Bangladesh. Methods: Two hundred twenty diabetic patients hospitalized with AMI were included in this study from the Department of Cardiology of Chittagong Medical College Hospital from March 2023 to February 2024. Admission blood glucose and HbA1c were measured, and the glycemic gap was calculated. Patients were prospectively followed during their hospital stay to obtain data regarding major adverse cardiac events (MACEs). Results: The mean (±SD) age of the patients was 56.5 (±10.1) years and 63.6% of them were male. MACEs included in-hospital death, cardiac arrest, cardiogenic shock, arrhythmia and left ventricular failure were observed in 6.4%, 3.6%, 19.5%, 5.5%, and30.5% of the patients, respectively. Ninety-nine (45%) patients had one or more MACEs. Median (IQR) glycemic gap values were 38.5 (31.9-47.3) and 71.0 (61.0-84.3) in patients without any MACEs and patients with one or more MACEs, respectively (p<0.001). Median (IQR) glycemic gap values were 90.6 (86.0-97.9) and 52.6 (36.1-69.3) in expired and survived patients, respectively (p<0.001). The area under the receiver operating characteristics curve (AUROC) for admission glycemic gap values to predict in-hospital mortality was 0.895[95% confidence interval (CI) 0.768-1.000, p<0.001] and with the best cut-off value of 80.16, glycemic gap had sensitivity and specificity of 92.9% and 89.8%, respectively.The Area Under ROC for admission glycemic gap values to predictMACEs was 0.926 (95% CI 0.874-0.958) and with the best cut-off value of 53.19, glycemic gap had a sensitivity and specificity of 94.9% and 84.3%, respectively. Glycemic gap was an independent predictor of MACEs [odds ratio (OR): 1.11, 95% CI 1.08-1.14, p<0.001] and in-hospital mortality (OR: 1.09, 95% CI 1.05-1.14, p <0.001). Conclusions: Elevated glycemic gap was significantly associated with an increased in-hospital mortality and other MACEs. So, glycemic gap can be used to assess the prognosis of hospitalized AMI patients with diabetes.