Background: The permanent cessation of menstrual periods in menopause causes a decline in estrogen levels and increased oxidative stress. Both of these factors lead to menopausal symptoms, cardiovascular diseases and osteoporosis in the postmenopausal females that negatively affect the quality of their lives. Antioxidant properties of Nigella sativa are due to its natural ingredient “thymoquinone” and have been studied in various animal and human studies. This study was done to determine beneficial effect of nigella sativa. Material and Methods: Thirty postmenopausal females were recruited in the study after taking consent. Nigella sativa was administered at a dose of 1g/day for 2 months after breakfast. Blood sample was taken for pre and post treatment glutathione (GSH) estimation. The SPSS version 21 was used to analyze the data. Paired t- test was applied. P value of< 0.05 was considered significant.Results: Regarding the effect of the Nigella sativa on oxidative stress, result indicated a highly significant increase from baseline (p<0.0001) after 8 weeks’ consumption of Nigella sativa. The effect size was calculated both for biochemical parameter GSH and general parameter like weight and BMI. The result of the effect size calculation showed larger effect size for GSH levels (3.9) and moderate sized effect for weight and BMI.Conclusion: Nigella Sativa showed beneficial antioxidant effects in post-menopausal females and might be responsible for a better quality of life in these women.

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Masseter muscle rigidity following administration of succinylcholine for induction of general anesthesia is considered an early warning sign for the possibility of an episode of dreaded complication i.e., malignant hyperthermia. This report describes a case of masseter muscle rigidity encountered at the start of an emergency surgical procedure. After succinylcholine administration, laryngoscopy and intubation were not possible due to the masseter muscle spasms. This led to the use of laryngeal mask airway and propofol for the successful conclusion of the procedure with no intraoperative or postoperative complications. Later, the patient was discharged with instructions to avoid the contributing triggers in the future and recommendations of caffeine-muscle biopsy.

Peripartum Cardiomyopathy (PPCM) is a pregnancy-associated cardiac disorder, which is potentially lifethreatening and manifests as left ventricular dysfunction and heart failure. The disease is rather rare and in most patients cardiac function recovers well, but long-term morbidity and mortality are not uncommon. Research studies suggest pregnancy-induced hormones and mediators, which cause vascular dysfunction, trigger that peri-partum cardiomyopathy. Genetic factors are also thought to play a role in pathophysiology. Management of peri-partum cardiomyopathy is same as cardiac failure and drugs against mediators like prolactin are under investigations, but no proven disease-specific therapies had been reported. We report a case of 35-year-old female who, instead of heart failure, had hypertension as sole presenting complaint of PPCM. Complications associated with PPCM are severe progressive heart failure, arrhythmias, heart block, cardiopulmonary block and thromboembolism. Death could be caused by worsening heart failure, arrhythmias and cardiopulmonary block.

Background/Aims Steroids are commonly used for immunosuppression in the majority of rheumatology conditions. Patients on long-term steroids are vulnerable to adrenal insufficiency during acute illness or if steroids are stopped or weaned down abruptly. During the COVID-19 pandemic, this risk has further multiplied due to change in practice with inclusion of telephone consultations and less frequent hospital visits. Although our patients were routinely provided with steroid alert cards by pharmacy, we aim to ascertain the knowledge and understanding of sick day rules in patient who are on steroids for immunosuppression. Methods We designed a novel questionnaire consisting of 10 questions, designed to determine patients’ knowledge about steroid sick day rules. All questions were close-ended, either single best answer or yes/no except question about primary rheumatological condition and type of steroids. A total of 100 patients (including new and follow-ups) attending rheumatology clinics between January and June 2020 were screened and selected randomly. Questionnaires and consent forms were sent by post as agreed with clinical effectiveness team with return envelopes. Results 29 completely filled questionnaires were received back. The majority of patients (96.5%; n = 28) were on prednisolone and only 3.44% (n = 1) were on hydrocortisone. The majority of the patients (95.6.6%; n = 29) were on steroids for duration between 1-6 months. Answering the question on steroid dose during an acute illness,10.3% (n = 3) patients had knowledge to take double dose of steroids, 55.1% (n = 16) responded to take regular dose, 3.44 (n = 1) answered by lowering dose to half, and strikingly 10.3% (n = 3) answered to stop steroids. For further question on when to seek medical advice during an acute illness while on steroids, 31.0% (n = 9) responded by answering correctly, 37.9% (n = 11) were unsure when to take medical attention, and 3.44% (n = 1) responded to wrong option. Despite providing steroids alert cards to everyone, only 65.5% (n = 19) answered yes on asking about carrying alert card with them. Conclusion Despite providing steroid alert card and verbal information, these data highlight a significant dearth of knowledge and understanding about sick day rules among rheumatology patients on steroids for immunosuppression. This knowledge gap increases the risk of potentially life-threatening emergency of adrenal crisis among this patient group. To bridge this knowledge gap, we started to provide steroid sick day rules written information leaflet to all new and old rheumatology patients on steroids to reduce risk of future adrenal crisis. We are aiming to re audit this after 1 year to check improvement in patient knowledge and understanding of sick day rules with this change in practice. Disclosure H.M. Umair: None. W. Clark: None. R. O'sullivan: None. F. Fawthrop: None.