COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

Gangrene is always considered untreatable and can only be stopped by amputation. Often the surgery fails to remove all the infection and more of the limb has to be cut off. This is a report about stopping gangrene with a non-invasive treatment taking only a few minutes and not using any drugs.

MED12 is a member of large Mediator complex; has a very crucial and central role in RNA polymerase II transcription; regulating cell signals involved in growth, development and differentiation. Different MED12 mutations may have different clinical presentation representing an allelic disorder. Maat-Kievit-Brunner (MKB) type Ohdo syndrome; has a typical facial features comprising of blepharophimosis, ptosis, long flat philtrum with thin vermilion, micrognathia with microstomia, scrotal hypoplasia with cryptorchidism, joint hypermobility with clinodactyly with overriding toes, A primigravida on antenatal ultrasound was detected to have growth restriction, corpus callosal dysgenesis, syndactyly and suspected ambiguous genitalia. Invasive testing and exome sequencing revealed hg19chrX:MED12:c.2315A>G: (p.Lys772Arg);MED12(NM_005120.3):c.2315A>G: (p.Lys772Arg) leading to provisional diagnosis of X linked Ohdo syndrome with an overlap with FG. Missense mutation was classified to be PM2; PP3 (ACMG) Clinical presentation, phenotype and mutational analysis led to provisional diagnosis of X linked Ohdo syndrome. Maat-Kievit-Brunner type of Ohdo syndrome is a rare condition and this is probably the first case describing foetal phenotype of MKB type of Ohdo syndrome.

Midline maxillary diastemas have been known to have a detrimental effect on facial aesthetics. Orthodontics can successfully close a diastema using fixed appliances. Porcelain restorations bonded with fixed appliances may suffer damage. A case is presented where a fixed appliance was used to close a midline maxillary diastema bypassing porcelain veneered central incisors. Palatal attachments were used to optimise tooth movements and the porcelain veneers were left intact.

Background and Aim. Currently two forms of levothyroxine are presented in pharmaceutical market of Armenia: Euthyrox and L-thyroxine. Local physicians have a choice of two different levothyroxine preparations, each of them with different dosage from 25 to 150mg. Oral levothyroxine (LT4) is the standard therapy for patients with hypothyroidism. The purpose of this report is to describe the adverse outcomes reported by endocrinologists, the frequent prescribers of levothyroxine, practicing in Armenia and to compare the rate of adverse reactions with data from different international research reports. Materials and methods. A Pharmacovigilance questionnaire was developed based on the literature reports to assess potential adverse events attributable to the use of levothyroxine products. Statistical Analysis Results were collected, interpreted and presented as percentages. Results. The study was with a cross-sectional design conducted in medical centers of Armenia using convenience sampling. The respondent parents of patients were selected using simple random sampling. Of the total 56 survey responses received, the majority 35 [63%]) reported no adverse events. The adverse effects were due to new or unexpected symptoms in 2 (25%), a TSH change alone in 1 (12%), or both in 6 (75%). Most the symptoms (5/8 [65%]) were consistent with thyrotoxicosis, arrhythmias were documented in three cases, while 35% (3/8) of cases had symptoms typical of hypothyroidism. Conclusions. Clinicians prescribing Euthyrox and L-thyroxine should be reminded that these products are from different manufacturers and patients/physicians should be made aware of all possible adverse reactions results, which could be different for these two products.