Empathy is considered a core element of professionalism in medicine in the era of patient-centred care. Physicians with higher levels of empathy have greater clinical competence and deliver improved physician empathetic communication resulting in better patient outcomes. Empathy contributes to patient compliance, patient enablement and clinical outcomes. Studies done across the world have pointed to a decline in the empathy levels among health professional students as they progress through undergraduate education and training. Medical curricula should provide ample opportunity for students to develop empathy and display-related attributes such as emotional intelligence and self-esteem. Curriculum reform in medicine is needed to enable mandatory training to teach and inculcate these attributes to help physicians have better patient interactions and ultimately improve the quality of care.

Disability is a complex issue. The concept of disability evolves over time from a charity to the right-based approach. It is a tremendous public health concern worldwide. We cannot achieve Sustainable Development Goals by leaving behind the persons with disabilities. In this article, readers will know the evolving basic concepts of disability, disability models and so on. Persons with disabilities faced unjustified discrimination in society. They are excluded from education and employment opportunities. This group of people faced great difficulty in accessing primary health-care services. Persons with disabilities are the biggest minority group in the world. They are neglected in the family ground to the community, community to the national level and national level to global ground. This manuscript primarily focuses on disability in Bangladeshi perspectives. Readers can find existing legal frameworks to protect the rights of people with disabilities in Bangladesh. The various types of disabilities considered by the legal frameworks of Bangladesh. They will also know the current employment opportunities of persons with disabilities in Bangladesh and the economic costs of disability in Bangladesh.

The ataxia-telangiectasia-mutated (ATM) and ataxia-telangiectasia-mutated and Rad3-related (ATR) DNA damage repair pathways serve as the surveillance system which keeps a check on different types of DNA damages and lesions, which includes DNA single-strand breaks, DNA double-strand breaks and other aberrant structures such as arrested replication forks during replication. The ATM and ATR kinases belong to PIKK class of kinases which activate a large number of downstream mediator and effector molecules. The main classes of effector kinases activated by ATM and ATR are checkpoint kinase 2 and checkpoint kinase 1, respectively. ATR works primarily with the RAD9-RAD1-HUS1 (9-1-1) complex, whereas ATM works with the MRE11– RAD50–NBS1 complex. Together ATM and ATR kinase protects the cells' genomic integrity and prevents random mutations to be carried into their progeny.

Introduction: Disability is an indicator for the measurement of health status in the elderly, and various researches have shown that the disability has an inverse effect on the quality of the elderly patients' life. Due to the increasing population of the elderly in our country, this study was conducted to evaluate the relationship between disabled elderly patients with mental problems, in order to reduce its psychological effects on them. Materials and Methods: This cross-sectional study was performed on 300 elderly people in twenty regions of Sabzevar. Data collection tools were World Health Organization Disability Assessment Schedule II, LOTR and Child Health Questionnaires. Data were analysed using descriptive statistics and regression by SPSS software. Results: The average age of the sample was 68 years. In this study, 3.1% had a mild disability and 7.98% of them have disability above average. The results reveal that the disability has significant effects on elderly patients, meaning that the higher the grade of disability, the higher the anxiety and the lower the happiness and optimism. Conclusion: Considering the higher incidence of disability in Sabzevar (east of Iran) among elderly people compared to other studies and its effects on anxiety, happiness and optimism, some mental health problems may arouse due to co-occurrence with disabilities.

Objective: The study addressed the comparable effects of premedication with dexmedetomidine (DEX), remifentanil (REM) and labetalol (LAB) before electroconvulsive therapy (ECT) on haemodynamic responses and seizure duration in psychotic patients. Materials and Methods: A double-blinded trial recruited four randomised groups of patients undergoing ECT (N = 144), including 0.5 μg/kg DEX, 0.2 mg/kg LAB, 1 μg/kg REM and 20 ml normal saline, respectively. The mean arterial pressure (MAP), heart rate (HR) and saturated oxygen were recorded every 5 min until the patient was transferred to the department. Besides, the recovery time, seizure duration and satisfaction were recorded. Data were analysed in SPSS software using analysis of variance and repeated measurement tests. Results: The MAP and HR were lower in the DEX (P < 0.001) with the longest recovery time (P < 0.001), while the time was lower in the REM. The DEX group showed shorter seizure duration, lower selected energy (P < 0.001) and the highest satisfaction (P < 0.001). Conclusion: The DEX patients appeared to have the highest satisfaction with the shortest seizure duration, as well as the lowest energy used in ECT, and if appropriate useful psychiatric treatment is provided, this adjuvant can be a great option for patients undergoing the therapy, but this reduces BP/HR while prolonging recovery time.

Background: Fibrous dysplasia (FD) is a less common benign bony fibro-osseous lesion, which is divided into two main kinds: monostotic FD and polyostotic FD (PFD). The natural history or aetiopathogenesis of FD is poorly understood, and treatments are still controversial. Methods: A review of the literature was performed to analyse and discuss the diagnosis and management of FD through a case report and literature review. Results: The current case of a PFD patient, which is usually presented in late childhood or early adulthood, is sometimes associated with endocrine disorders such as McCune–Albright syndrome (MCA). Computed tomography-guided biopsy from the lytic bone area is a useful technique for the evaluation and diagnosis of disease, though the accuracy of the histopathology findings has been not conclusive. Exclusion of other lytic bone lesion disease is the mainstay of diagnosis. All medical and surgical treatments are valid; no one has been proven to be better. The present case is reported because it illustrates specific points of differential diagnosis, such as multiple myeloma, hyperparathyroidism, primary bone malignancy, secondary metastasis in bones, sarcoidosis or granulomatous disease of bone. Conclusions: In the current case, surgical repair of the bone is not possible due to extensive involvement in different sites of the bones, and there is no mechanical compression in any neurological structures, hence medical management was chosen. There is no gold standard in medical or surgical treatment, and each treatment should be individualised. Only medical management shows good results in such cases.

Thyrotoxic periodic paralysis (TPP) is a disorder comprising acute hypokalaemia, intermittent muscle weakness and thyrotoxicosis. TPP is a rare manifestation of thyrotoxicosis predominantly seen in Asian people. We reported a patient who was brought to the emergency department with acute onset of weakness of her lower limbs. After a series of investigations, the patient was diagnosed as a case of thyrotoxicosis. The patient was placed on carbimazole, which prevented further attacks. The patient's improvement was satisfactory, and she is currently symptom free. Because of the presenting feature, its precipitating factor, the absence of a family history of periodic paralysis and the improvement of a clinical parameter after the starting of the antithyroid treatment, the condition was diagnosed as thyrotoxic periodic paralysis. The physician should concern about thyrotoxic periodic paralysis in people who present with weakness and features of thyrotoxicosis. A high prediction, early diagnosis and treatment of the condition can prevent severe complications, such as cardiac dysrhythmia.