Background: Chronic liver disease (CLD is a common disease all over the world and the major cliological factors for the causation of disease are HBV and HCV in this country and Alcoholic liver disease in the western world. With the availability of the modern treatment, the life expectancy is increased now a days. But the long term complications are now evident. One of the complications is hepatic osteodystrophy which is associated with deficiency of vitamin D. Vitamin D undergoes hepatic 25-hydroxylation, but as the hepatic parenchyma is jeopardized so the metabolic activation of this vitamin is impaired. Vitamin D deficiency is highly prevalent in CLD patients and vitamin D level is inversely related to the severity of the disease. Objective: To assess the concentration of 25-hydroxy vitamin D in chronic liver disease patient in different etiology and to study the relationship of level of 25(OH) D in different stages of the disease according to Child-Pugh classification. Methods: This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of April 2015 to March 2016. Patient attending the Gastroenterology Department who fulfill the inclusion criteria with cirrhosis of liver were initially be enrolled for the study. Their clinical history, examination and initial investigation report were noted in the standard data sheet. After explaining the study objective, informed consent was taken. The diagnosis of liver cirrhosis was made by combination of clinical features, blood profile and transabdominal ultrasound. Endoscopy of the upper GIT was done to see the presence of oesophageal or gastric varices which is a sign of increase portal pressure. Transabdominal ultrasound demonstrated a shrunken liver with increase echogenicity, with or without splenomegally and presence or absence of ascites. Stages of liver disease were assessed by Child-Pugh scoring system. Level of 25(OH) D was measured from blood with the permission of the Department of Bio-chemistry. Data was collected using a structered data sheet. Results: Out of 85 patients, male were 61 (71.8%) and female were 24 (28.2%). Mean age was 53.0 ± 10.7 years within tin- range of 25-70 years. More than 90.0% patient* had abates and anorexia. Eighty percent patients had weight loss and 71.8% patients had Jaundice. More than 40.0% patients had abdominal pain and melaena. Sixty (77.9%) patients had history of blood transfusion and 73 (94.8%) patients had previous hospitalization, Most of the patients had anaemia (97.6%) and Splenomegaly (92.9%). More than 50.0% patients had jaundice (61.2%), Leukonychia (61.2%) and hone pain (52.9%). Mean s, vitamin 25(OH) D was 16.29 ± 7.96 in 69 HBV patients and 20.14 ± 9.76 in 16 HCV patients. In this study, 28.2% patients were in child Pugh A, 36.4% in child Pugh B and 32.9% in child Pugh C stages. Mean s. vitamin 25(OH) D were 27.12 ± 6.11, 15.97 ± 5.40 and 9.57 ± J.I5 in Child-pugh A, Child-pugh B and Child-pugh C stages respectively. Mean s. vitamin 25(OH) D was gradually decreased as the changes of stage from lower to higher. Conclusion: Vitamin D deficiency is highly prevalent in patients with CLD and inversely correlated with disease severity. In the case of chronic liver diseases, vitamin D seems to modulate the innate and adaptive immune system, which explains the association. In fact, clinical studies suggest that these parameters may improve with vitamin D supplementation. So, monitoring of S. 25(OH) D is reasonable in CLD patient.

Intestinal malrotation is a rare congenital anomaly that originates from the failure of the normal rotation and fixation of the midgut during embryologic development. There are different types of Midgut Malrotation which includes non-rotation, incomplete rotation, reverse rotation, or anomalous fixation of the mesentery. Methods: We present a case of a 58-year-old woman with a BMI of 45.3 kg/m2. The patient underwent laparoscopic appendectomy 15 years ago and was diagnosed with a partial situs inversus. She has no other past medical conditions. Results: At the operation, four meters of small bowel were counted backward from the ileocaecal valve until the duodenum. We performed a one anastomosis gastric bypass with three meters of common limb and one meter of biliopancreatic limb, gastro-intestinal anastomosis made with a linear stapler, and the defect sutured with absorbable suture. Conclusion: One anastomosis gastric bypass is a feasible and safe alternative for morbidly obese patients with intestinal malrotation or multiple intestinal adhesions.

Although the term “lifestyle medicine” was first used as the title of a symposium in 1989 and of an article in 1990, its concept is not new. The towering figures in medicine: Huang Ti (2698-2598 BCE), Hippocrates (460-377 BCE) and Ibn Sina (980-1037CE) had the credit to link the natural effects of diet, lifestyle, emotion and environment with the preservation of health. Unhealthy lifestyle behaviors, a well proven primary source of the global burden of chronic diseases, are among the leading risk factors for increased disability-adjusted life years around the world. While, Gastroesophageal Reflux Disease and Chronic Obstructive Pulmonary Disease augument each other, COPD and Obstructive Sleep Apnea have a common pathophysiology and are known to coexist leading Flenley to coin the term “Overlap Syndrome”, in 1985. Behavioral therapy on each modifiable item, including diet and weight management, physical activity, smoking, sleeping pattern, stress, and mood states have all been evaluated in the present study.

Background and Aims: Corona virus disease COVID 2019 is considered as serious pandemic. Esophagogastroduodenoscopy (EGD) is an aerosol generating process and may precipitate its transmission. The aim of this study is to assess new location for the endoscopist and supporting team during this era of COVID19. Methods: This study included 43 patients. Patients were classified into two groups, group 1 included 21 patients in which classic position of endoscopic staff members was done, maintaining the personal protective equipment and the group 2 included 22 patients in which the endoscopist and staff members stand behind the patient. Results: There is no significant statistical difference between groups regarding the time needed for completing the endoscopic process, the success of the maneuver or the satisfaction of the patient about the maneuvers (P = 0.839, P = 1, P = 0.721) respectively, the endoscopist has to do additional movements by his shoulders or his wrists in group II more significantly than in group I (p=0.012) Conclusions: Standing of the endoscopist behind the patient while performing EGD is as effective as the standard classic one. In simple upper gastrointestinal UGI endoscopic maneuvers, it may be more protective for endoscopic staff members in the era of pandemic COVID19.

Current clinical guidelines for albumin use in decompensated cirrhosis recommend the use of intravenous albumin infusions for management of ascites-related symptoms and paracentesis (removal of ascitic fluid) and for the management of spontaneous bacterial peritonitis (SBP), renal dysfunction and variceal bleeding. Routine albumin use is not recommended for the management of non-SBP infections. The aim of this review is to improve our understanding of the effects of albumin use in cirrhosis by reviewing the currently available and quantifying the effectiveness of intravenous albumin therapy to prevent specific cirrhosis complications, spontaneous bacterial peritonitis (SBP) and renal dysfunction. Long-term albumin administration to patients with decompensated cirrhosis improves survival, prevents complications, eases the management of ascites and reduces hospitalizations, thus being cost-effective. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.