upper gastrointestinal bleeding, uncommon cause, diagnosis, treatment Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.

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Background: Abnormalities in serum lipid and lipoprotein levels (Dyslipidaemia) are recognized as major modifiable cardiovascular disease (CVD) risk factors and have been identified as independent risk factors for essential hypertension giving rise to the term dyslipidemic hypertension. The present study was conducted to assess patterns of dyslipidaemia amongst hypertensive patients. Materials and Methods: 76 hypertensive patients of both genders were recruited. Group I consisted of hypertensive patients and group II had healthy control. Systolic (SBP) and diastolic (DBP) blood pressures, Body mass index (BMI), Fasting blood glucose and fasting serum lipid profile was recorded. Results: Group I had 40 males and 36 females and group II had 38 males and 38 females. In group I and group II, SBP (mm Hg) was 162.4 and 116.4, DBP (mm Hg) was 98.4 and 70.2, BMI (kg/m 2 ) was 28.6 and 26.2, WC (cm) was 96.4 and 90.4, WHR was 0.98 and 0.94, FBS (mmol/L) was 5.1 and 4.6, TG was 1.24 and 1.10, HDL-c was 1.26 and 1.24, LDL-c was 3.01 and 2.42 and TC was 4.82 and 4.15 respectively. Elevated TC (≥5.2 mmol/L) was seen in 34% and 7.5%, elevated TG (≥1.7 mmol/L) in 7% and 1%, elevated LDL-C (≥3.4 mmol/L) in 29% and 6.2%, low HDL-C (<1.04 mmol/L) in 22% and 15%, no lipid abnormality in 46% and 72%, one lipid abnormality in 20% and 16% and >2 lipid abnormality in 24% and 12% in group I and II respectively. Conclusion: There was high patterns of dyslipidemia amongst hypertensive patients as compared to healthy subjects.

Background: Nucleated RBCs are a common observation in the circulating blood of newborn. Number of nRBC in cord blood and perinatal asphyxia shows good correlation. Perinatal asphyxia ranks as the second most important cause of neonatal death after infections accounting for about 30% mortality worldwide. Objective of the present study was designed to find the relation between umbilical cord blood nRBC count and perinatal asphyxia.Methods: The present one-year prospective case control study was carried out. A total of 100 babies divided into two groups of 50 each as cases and controls. Term babies with perinatal asphyxia were enrolled as cases and term babies without perinatal asphyxia born during same period were included as control.Results: The distribution of cord blood pH in cases showed maximum babies (80%) with pH value of <7 and 38% of the children were detected to have HIE stage II followed by 26% with stage I and 4% with stage III. At admission, 48 hours and 72 hours, significantly higher number of babies were found to have higher cord blood nRBC count (p<0.001) and the mean cord blood nRBC count was found to be significantly high at all the intervals (p <0.001). Comparison of mean cord blood nRBC count among cases in stage III was significantly high compared to stage II and I (p<0.001) at admission, 48 hours and 72 hours.Conclusions: Cord blood nRBC can be used as surrogate marker for asphyxia. The clearance of nRBC from the circulation may be of help in prognosticating the outcome of asphyxiated babies.

Mitochondria are referred to as the energy centers of cells, and mitochondrial DNA are known to alter the mitochondrial respiratory chain, which reduces cellular energy and causes ion-channel malfunction and neuronal cell death. As majority of the cells contain mitochondria, these disorders involve multiple systems. Since the energy requirements of different tissues vary, their vulnerability to mitochondrial dysfunction also varies in terms of threshold. This causes these disorders to appear clinically in a variety of ways and with significant phenotypic overlap. The genotypic and phenotypic definitions of some specific symptoms are, nevertheless, well established. Potentially deadly mitochondrial toxins are present in some epileptic medications and early diagnosis of the condition can help prevent serious morbidities. We describe a typical case of sodium valproate and lamotrigine-induced fast multiaxial worsening in a patient with myoclonic epilepsy with red ragged fibers (MERRF) as these drugs act as mitochondrial poisons and could prove life threatening for patients with mitochondrial diseases. When mitochondrial cocktail was introduced and the problematic medicines were removed, the symptoms were somewhat reversed. MERRF in progeny of non- consanguineous parents is a rare occurrence resulting in poor prognosis of the disease. Epileptic drugs lamotrigine and sodium valproate should be avoided as these drugs worsen myoclonus and cause mitochondrial toxicities. With knowledge of the information in this scenario, further harm to the patient can be prevented.