Rhabdomyolysis is characterized by muscle necrosis and leakage of toxic intracellular contents into the circulatory system. It is most commonly caused by trauma, physical exertion, drugs, toxins, and a variety of infections; only rarely is it associated with acute human immunodeficiency virus (HIV) infection alone. The severity of illness ranges from asymptomatic elevations in serum muscle enzymes to life-threatening electrolyte imbalances and acute kidney injury. High HIV viral load is associated with higher muscle breakdown that increases the incidence of severe acute kidney injury and sometimes the need for renal replacement therapy. The introduction of highly active antiretroviral therapy (HAART) revolutionized the treatment of HIV infection and increased the life expectancy of such patients by suppressing viral replication. Myopathy is one of the neuromuscular manifestations of HIV. It can occur either as a result of a complication of HIV itself or as a result of medicines used to control HIV. Muscle involvement of HIV infection ranges from asymptomatic muscle enzyme elevation to severe, HIV-associated polymyositis or pyomyositis. Here we report a case of acute retroviral syndrome presenting as severe non-traumatic rhabdomyolysis.

A 38-year-old lady presented to the Ibn Sina Breast Care Centre, Dhaka with the complaints of bloody discharge through the left breast nipple. On examination, there was spontaneous bloody discharge from left breast nipple through a single duct. There was no mass on palpation. She was then referred for ultrasonography and ductography of the left breast. USG showed multiple cysts, however no intracystic solid portion could be noted. Ductography revealed dilated duct with contrast agent filling defects approximately 2.9 cm from the nipple and sudden cut-off of the contrast column about 3.7 cm from the nipple. Findings are consistent with intraductal papilloma with duct ectasia. Fig 1. Galactography of left breastAbnormal nipple discharge is associated with an underlying malignancy in 1.2% to 15% of patients. 1 Abnormal discharge is defined as nonlactational, persistent, spontaneous, and unilateral. 2 Bloody or hemoccult-positive discharge is more likely to be associated with cancer (5% to 28%) and should prompt further evaluation. 3 However, clear or watery discharge has been associated with breast cancer in up to 7% of cases. 1 Mammography is advocated as part of the routine evaluation of women with breast complaints. Mammography is associated with a 9.5% false-negative rate and a 1.6% false-positive rate in detecting breast cancer in patients with nipple discharge. 4 Ductography is an increasingly available method of examination and is relatively easy to perform with few complications. Ductography has been shown to be accurate in providing the location and depth of ductal abnormalities when a single duct is identified as the s o urce. 1 D a ta regarding the location of the lesion greatly facilitate biopsy, especially with deep lesions. Ductography has also been shown to improve the diagnostic yield of surgical biopsy from 67% in nonstudied patients to 100% in patients receiving a ductogram. 5

Dietary supplements do not need prior Food and Drug Administration (FDA) approval before they are sold to the public per Dietary Supplement Health and Education Act of 1994 (DSHEA). Reporting serious dietary supplement related adverse reactions is voluntary. Hydroxycut is a brand of dietary supplements that are marketed as a popular weight loss product that contains multiple herbal constituents. Due to its potential hepatotoxic effects, FDA issued a warning in 2009 and recommended that consumers discontinue use of Hydroxycut. Hydroxycut was recalled from the market but a reformulated herbal mix is now available again. We are presenting a case of acute liver injury associated with Hydroxycut. The prominent pattern of liver injury is severe hepatocellular injury with the striking elevation of the aminotransferase levels and minimal abnormalities in alkaline phosphatase levels. It can sometimes cause severe hepatocellular necrosis.

To determine the incidence of gastric cancer in patients who previously suffered from esophageal webs coming to tertiary care hospitals of Karachi, Pakistan.

Lymphocytes are a subset of white blood cells (WBC) that forms a framework of the immune system. They facilitate humoral and cellular immunity of the body against foreign proteins and pathogens. An increase in circulating lymphocytes (lymphocytosis) can be seen following infections such as infectious mononucleosis and pertussis, or in lymphoproliferative disorders. Lymphoproliferative disorders (LPD) are known complication of primary immunodeficiency (PID). Viruses can cause number of primary infections that leads to different complications and induces malignancies. Primary infections in infants and children are common and usually asymptomatic. Outcome of LPD is very poor. Mortality rate is approximately 75%.