Background: Candida albicans, is a normal flora that lives on the oral mucosa, digestive tract and vagina. Candida albicans can cause infection such as oral candidiasis. A number of antifungal agents are widely used in the treatment of Candida infections, but some antifungal drugs sometimes have unpleasant side effects. This prompted researchers to examine the contents of natural ingredients that have antifungal activity, one of which is cinnamon. Cinnamon (Cinnamomum burmannii) contains several chemical compounds including cinnamaldehyde and eugenol which are components that have antifungal effects. Objective: to analyze the effectiveness of cinnamon (Cinnamomum burmannii) antifungal against Candida albicans. Materials and Methods: The research was performed as laboratory experiment that calculates the diameter of inhibition using the agar-well diffusion method. 25 samples tested were Candida albicans cultured in SDA (Saboroud Dextrose Agar) medium. Variations in treatment concentrations were cinnamon extract (Cinnamomum burmannii) 25%, 50%, 75%, nystatin oral suspension (positive control), and aquades (negative control). Results: The average inhibition of 75% cinnamon extract (Cinnamomum burmannii) was 16.8 mm, whereas in the positive control nystatin oral suspension was 13.4 mm. The hypothesis test has a value of p=0.000 (p<0.05). Conclusion: There is an antifungal effectiveness of cinnamon (Cinnamomum burmannii) against Candida albicans at a concentration of 75%.

Sarcopenia, characterized by the decline of skeletal muscle mass and function, can have severe consequences for older adults, including disability and frailty. The condition is also linked to various diseases, increased insulin resistance, fatigue, falls, and mortality. Factors such as obesity and myosteatosis (fat infiltration into muscle) play a significant role in driving sarcopenia, particularly in morbidly obese individuals who also have low muscle mass, known as sarcopenic obesity. The Framingham study found additional limitations in function and mobility in individuals with sarcopenic obesity. This literature review aims to provide the potential causes of sarcopenia, with a specific focus on middle-aged adults, the biological processes that lead to muscle loss, methods to mitigate its effects, and how physical activity and nutrition can aid in recovery.

Bicuspid aortic valve disease (BAV) is a congenital disease that frequently produces complications during adulthood, and is considered not only a problem of valvulogenesis, but also a more complex genetic alteration that involves the development of the heart and the aorta, which entails a high morbidity and mortality in these patients. In 50% of adults with this pathology, non-valvular anomalies are observed, with dilation of the ascending aorta being the most common. Genes such as NOTCH1, UFDL1, ACTA2, eNOS, among others, have been identified as responsible for the appearance of aneurysms, which increases the risk in these patients of complications such as aortic dissection and its subsequent rupture. Painless aortic dissection may be seen in less than 5% of patients and may have an atypical clinical presentation. A case and review of the literature is presented in which we can observe the great complexity of this pathology, in the case of a patient with BAV, annulo-ectatic dilation of the aortic root and ascending aorta who developed heart failure, syncope and presented as a complication Stanford type A aortic dissection, requiring highly specialized surgical treatment.

Background: For neonates that survive preterm labor, neurological illness still ranks as one of the main causes of perinatal mortality. Researchers have hypothesized that maternal recto-vaginal colonization with group B Streptococcus and asymptomatic bacteriuria during pregnancy might be risk factors for preterm birth. This study is to determine whether there is any connection between preterm birth, asymptomatic bacteriuria, and maternal group B streptococcus colonization. Patients and Methods: From January 10 to September 6, 2020, Salah Al-Deen General Hospitals obstetrics and gynecology department conducted a clinical based case control research. In the research, group 1 consisted of (50) women who had preterm labor (24–36+6 weeks), whereas group 2 consisted of (50) women who had full-term pregnancies. A questionnaire, as well as a general and abdominal examination, were used to gather the data. By collecting a high vaginal swab and sending it for microbiological analysis, all patients were screened for genital colonization with Group B streptococcus. Urine cultures were used to check all patients for asymptomatic bacteriuria. Results: Preterm births most frequently occurred in women between the ages of 25 and 29 (46%). The majority of women who gave birth prematurely came from rural regions, 30 (60%), were moms who worked at home, 42 (84%) and just 8 (16%) were employed. Positive urine cultures were detected in 10 (20%) more preterm births than in 3 (6% of full-term laboring mothers). A 30% detection rate of Group B Streptococcus was found in premature labor. 11 (22%) of preterm-born women had positive vaginal swaps for Group B Streptococcus, which is much more than the 4 (8% of full-term-born women). Conclusions: E. coli made up the majority of the bacteria that were found, followed by Group B Streptococcus colonization. Women who had preterm deliveries had considerably more positive urine cultures for Group B Streptococcus than those who had full-term deliveries.

Hereditary blood disease are so common inherited problems in the world and in Iraq ,as far as the life span of the patients did increased psychosocial problems are greatly expected to increased and were studied through a different series through out the world ,the problem was understudied on the national prospect that nictitate a study to highlight the issue methodes:104 different diagnoses hereditary blood disease patient were enrolled in this cross sectional study that depend on direct interview and fill of 2 revised questionnaire that covered psycological,social and educational impact of the disease in a period of 6 months in Basra center for hereditary blood disease results: More than 50.96 % showed agreement toward being hopeless because of the illness,58.65 % agree for being nervous and upset ,59.62% for feels depressed and sad ,50% feel anxious for their future and 50.92% feel nervous because of the illness) Existence of psychological problems among the patients studied did concluded and issuing screening for the problems among the patients and establishing psychological help programs did recommended.

Contact dermatitis is an inflammatory condition of the skin that occurs when it comes into contact with specific substances or irritants. Cosmetics have been identified as a common cause of contact dermatitis. This research will review previous studies on the relationship between cosmetics and contact dermatitis. Research identifying the most common allergens and irritants present in cosmetic products will be analysed, as well as patch tests used to detect possible allergic reactions. The results of studies that have demonstrated the presence of allergens and irritants in cosmetics, as well as the associated skin reactions, will be presented. Contact dermatitis prevention and management strategies will also be discussed, including identification and avoidance of specific allergens, patch testing, and skin care guidelines. The discussion will focus on the importance of education for both consumers and healthcare professionals about the risks of cosmetics in contact dermatitis. In conclusion, cosmetics pose a hidden risk for the development of contact dermatitis. It is critical that both consumers and healthcare professionals are aware of the common allergens and irritants present in cosmetic products, and take appropriate steps to prevent and manage this condition.

Refusal to vaccinate also occurs in Indonesia, primarily because people are reluctant to provide basic immunizations to their children. Some of these reasons need to be clarified about immunization information. This research aims to determine the relationship between perceptions, subjective norms, and beliefs regarding the hesitancy of childhood immunization vaccines. The research method used was analytical observational with a cross-sectional approach using the chi-square test. The population is mothers with children aged two years or who have passed the immunization schedule for children aged 2 years, numbering 13,052 people. The sampling method used cluster sampling using the sample size formula, according to Slovin, to obtain a sample size of 389 people. The results show a relationship between perception and hesitancy of childrens immunization vaccines with a P-value = 0.003 (<0.05). There is a relationship between subjective norms and child immunization vaccine hesitancy with a P-value = 0.001 (<0.05). A relationship exists between confidence and hesitation about childrens immunization vaccines with a P-value = 0.000 (<0.05). The conclusion is that there is a relationship between perception, subjective norms, and beliefs on the hesitancy of immunization

Introduction: at the beginning and establishment of breastfeeding, adequate care routines are essential, such as its early initiation and skin-to-skin contact, which implies the need to facilitate the joint accommodation of the mother with the newborn in the immediate postpartum period, regardless of the type of delivery. Objective: to analyze the effects of mother and newborn rooming-in after a cesarean section on breastfeeding rates at hospital discharge and its maintenance up to two years later. Method: A prospective cohort study was conducted with a random sample of 146 women and their newborns, who were followed up for two years. The characteristic of cohort A was rooming-in of mother and newborn after cesarean section, whereas the characteristic of cohort B was separation of mother and newborn after cesarean section. Results: cohort A was made up of 67 mothers, 58 of whom were able to do skin-to-skin care after the cesarean section and 46 started breastfeeding during that period. Cohort B was made up of 79 mothers and none could make skin-to-skin contact or initiate breastfeeding. Conclusions: skin-to-skin contact after caesarean section, as well as avoiding the administration of supplements during this period, has a beneficial effect on the initiation and maintenance of breastfeeding; and this is possible thanks to joint accommodation.

The aim of this study is to reveal the incidence and morphometric features of the accessory foramen transversarium in the population in eastern Turkey. In the study, a total of 125 cervical vertebrae of unknown gender and age, located in the Anatomy Department of Ataturk, Erzincan Binali Yildirim and Kafkas University Medical Faculties, were used and accessory foramen transversarium was detected in 22 (17.6 %) of these cervical vertebrae. In this study, the area, vertical and horizontal diameters of the accessory foramen transversarium were measured for the first time. It was determined that the accessory foramen transversarium with the largest area was in C3-C6 (6.8 mm2) and the smallest area was in C7 (1.06 mm2). It was determined that the largest vertical diameter was C7 (2.38 mm), the smallest one was C3-C6 (0.91 mm), the largest horizontal diameter (3.66 mm), and the smallest (1.6 mm) were C3-C6. In addition, accessory foramen transversariums were typified. One foramen arcuate was also detected during the examinations. As a result, osteometric measurements of the accessory foramen transversarium were revealed. We think that these data will be an important reference in head and neck surgery, in the clinical approach of a. vertebralis, and in the evaluations of radiologists in the neck region.

Background: The most typical metabolic issue related to pregnancy is gestational diabetes. Because it eliminates undesired germs and causes inflammation, the complement system (C3) is an essential part of the cellular immune system. It has been linked to metabolic diseases, including diabetes, obesity, dyslipidemia, insulin resistance, and liver dysfunction. C3 is also becoming more well recognized as a risk factor for cardiovascular and metabolic diseases. Immunoglobulin levels in maternal blood and colostrum are decreased by hyperglycemia, which also affects IgG transfer across the placenta. Aim of study: to compare the levels of C3 and immunoglobulin G in the sera of pregnant women with gestational diabetes and their babies to pregnant women without the disease. Methods: a case control study that was carried out over the course of four months, from August 18 to December 20, 2020, at the department of obstetrics and gynecology at Salahaddin General Hospital/Salahaddin. It involved 92 pregnant women who separated into two groups and went to the delivery room to deliver a viable fetus: 47 pregnant women in the case group had been diagnosed with gestational diabetes mellitus, whereas the 45 pregnant women in the control group had no complaints and were matched with the other group ages and gestational ages. Results for C3 and IgG levels in maternal and cord blood were noted. Results: In this study, the case groups mean birthweight and maternal serum C3 levels were both considerably greater than those of the controls. The mean cord serum IgG level in the case group was substantially lower than that in the controls. Conclusion: Understanding the underlying chronic inflammation that affects the developing fetus innate immune system and predisposes the person to future diabetes and its consequences may be possible with complement C3 estimate in GDM.

This article provides an introductory exploration into the vaginal microbiota and its significance in maintaining gynecological health. The vaginal microbiota plays a crucial role in sustaining a balanced and harmonious vaginal ecosystem, influencing various aspects of reproductive well-being. By examining the composition and dynamics of the vaginal microbiota, this article highlights its impact on preventing dysbiosis and associated infections. A deeper understanding of the intricate interactions within the vaginal microbiota can pave the way for targeted therapeutic interventions aimed at promoting and preserving gynecological health.

Post-COVID-19 chronic suppurative gingivitis is an emerging clinical entity that has attracted increasing interest in the medical and dental community because of its association with SARS-CoV-2 virus infection and its prolonged and potentially debilitating manifestation in the periodontal system. This article provides a comprehensive review of this entity, addressing its epidemiology, pathogenesis, clinical manifestations, diagnosis and current therapeutic approaches. The epidemiology of post-COVID-19 chronic suppurative gingivitis is characterized by its occurrence following SARS-CoV-2 infection, with a variable incidence in convalescent patients. A higher prevalence has been observed in individuals with underlying systemic diseases, such as diabetes mellitus and arterial hypertension, suggesting an individual susceptibility component. From a pathogenic perspective, it has been postulated that SARS-CoV-2 infection could trigger an overactive immune response and chronic inflammation at the gingival level, contributing to persistent suppurative gingivitis. The involvement of viral factors and host response in the pathogenesis of this entity are under ongoing investigation. The clinical presentation of post-COVID-19 chronic suppurative gingivitis includes characteristic signs such as gingivorrhage, gingival edema, superficial ulcerations, and the production of purulent exudate in the gums. These findings, in combination with a history of SARS-CoV-2 infection, are critical for diagnosis.

Background: Assessing balanced nutrition knowledge and eating behavior among adolescent girls is important because they affect health and nutritional status, thus it needs measurement instruments that have been tested for validity and reliability. Objective: To assess the validity and reliability of balanced nutrition knowledge and eating behavior questionnaires among adolescent girls. Method: This study involved 30 Senior High School girls aged 15-18 years. The validity of the data was tested using difficulty level analysis, differentiating power analysis, distractor analysis, Lawshes Content Validity Ratio (CVR) analysis, and item discrimination test. The reliability of the questionnaire was tested using Cronbachs Alpha coefficient. Results: A total of 20 items regarding balanced nutrition knowledge were considered valid and 10 items about eating behavior were declared valid. The results of the reliability test of the questionnaire on balanced nutrition knowledge and eating behavior obtained Cronbachs Alpha values of 0.822 and 0.829, thus this questionnaire is declared reliable. Conclusion: The questionnaire on balanced nutrition knowledge and eating behavior has good validity and reliability values. The questionnaire can be used to obtain accurate and consistent data in order to assess the balanced nutrition knowledge and eating behavior among adolescent girls.

This study analyzed risk factors (ANC, pregnant womens Fe, exclusive breast milk, complementary breast milk, vitamin A, and growth monitoring) associated with stunting at the Karamat Community Health Center, Buol Regency. The sample in the research was 149 mothers of toddlers with children aged 12-24 months. The research design used an analytical survey using a cross-sectional study design. The study results showed a significant relationship between ANC examination, MP ASI, and Vitamin A administration with the incidence of stunting in the first 1000 days of life at the Karamat District Health Center. Buol with Odds Ratio (OR) values respectively 2.43, 3.42 and 7.32. Multivariate test results show that the vitamin A program consumption factor (incomplete) with OR = 7.1 has a greater tendency to experience stunting compared to the MP-ASI provision factor (inadequate) with OR = 3.2. However, the two elements, MP-ASI and vitamin A work together to determine the incidence of stunting in toddlers in this study. The conclusion from this research is that Vitamin A is The most dominant variable is related to the incidence of stunting. Therefore, it is recommended that all health workers improve services in the form of health education related to the stunting reduction acceleration program in the Buol district

Necrobiosis lipoidica (NL) is a rare dermatologic disease of uncertain origin characterized by the appearance of chronic, deep cutaneous lesions, predominantly on the legs of patients with type 1 diabetes mellitus. This article comprehensively addresses NL, exploring its intricate pathogenesis, clinical manifestations, and current therapeutic options. NL has become a clinical challenge due to its chronic and often refractory nature. Its connection with type 1 diabetes mellitus and the possible contribution of autoimmune factors in its development are highlighted. In addition, theories involving inflammation, microangiopathy, and collagen disruption as key components of its pathogenesis are discussed. The clinical presentation of NL is varied, ranging from well-demarcated erythematous plaques to painful and disfiguring ulcers. Differential diagnoses are meticulously addressed, and imaging techniques and skin biopsies are described as essential tools in diagnostic confirmation. In terms of therapeutic options, pharmacological approaches such as topical corticosteroids, immunomodulators, and emerging biologic therapies are discussed. The efficacy and safety of these options are critically evaluated, highlighting the need for a personalized approach for each patient. In summary, this article provides a comprehensive overview of necrobiosis lipoidica, from its underlying mechanisms to currently available treatment strategies. A thorough understanding of this clinical entity is essential to improve the quality of life of affected patients and to advance the search for more effective therapies in the future.

Tracheostomy is a surgical procedure most often performed on critically ill children and adults.1,2 It can be performed urgently or electively, the indications are divided by age group, one of the most common causes is the need for chronic mechanical ventilation. 3,4 The surgical technique that is preferred worldwide is the percutaneous dilatation technique with bronchoscopic control, since it has fewer complications, among these, higher rate of decannulation, fewer days of IMV, shorter stay in the ICU and low Charlson comorbidity index, compared to open tracheostomy. 5 Complications secondary to the procedure are divided into early and late, the most frequent being bleeding or hemorrhage, infection, obstruction of the tracheostomy tube, and injury to the posterior wall of the trachea.6,7,8

Background: Mycobacterium tuberculosis is among the leading causes of death, usually in underdeveloped countries, being the state of Baja California with most cases and deaths in Mexico. This infection can affect pericardium, although infrequent and it represents 1-4% of the cases of tuberculosis. The relevance of this presentation is the difficulty of diagnosis and high mortality. Objective: Demonstrate the importance of keeping the high suspicion that this type of tuberculosis in endemic entities because of high mortality and the existence of treatment. Description Of The Cases: 39 year old male who practiced sex with men and had multiple comorbidities. Referred to the emergency department to start antituberculous treatment. During his stay he presented deterioration of health. Pericardiocentesis was performed with results suggestive of Mycobacterium tuberculosis. He subsequently presents cardio respiratory arrest without spontaneous return of the circulation. The second case its about a 69 year old male who came into the emergency room with lower respiratory tract infection symptoms with two months of evolution and signs of cardiac insufficiency. An echocardiogram was performed meeting pericardial effusion which confirms the etiology of tuberculosis and started an antituberculous treatment with good evolution until discharge. Conclusion: Currently, in endemic zones of Mycobacterium tuberculosis is important to suspect this agent in view of typical presentation of infection and atypical presentation of frequent pathologies.

Pulmonary thromboembolism in pregnancy is a complication that directly impacts morbidity and mortality, the incidence is conditioned by the prothrombotic state during pregnancy and in the postpartum period, since the most important risk factor in this context is deep vein thrombosis, a condition that exponentially increases the risk of presenting thrombotic events such as pulmonary thromboembolism, in the clinical presentation there are no differences in this context, however it is important to note that to date there are no risk scales where pregnancy is included as part of the factors within a scale, so clinical diagnosis, biochemical and imaging is of vital importance, in order to reduce the potential complications and outcome of this group of patients.

This comprehensive review delves into the intricate landscape of surgical management in cases of a hostile abdomen. A hostile abdomen represents a formidable challenge characterized by factors such as severe adhesions, inflammation, abscesses, or the presence of foreign bodies, complicating surgical interventions. The preoperative phase is pivotal, requiring meticulous assessment and planning, often involving advanced imaging studies to anticipate potential complications. Surgeons must adapt to the unpredictable intraoperative challenges they encounter, such as dense adhesions and abscess drainage, employing skillful techniques to ensure patient safety. Minimally invasive approaches may be advantageous in select cases, minimizing surgical trauma and expediting recovery. Interdisciplinary collaboration among surgical specialties, anesthetists, radiologists, and nurses is essential to navigate these complex scenarios seamlessly. Potential complications, including prolonged operative times, increased blood loss, inadvertent injury, and postoperative infections, demand proactive management and comprehensive postoperative care. In conclusion, managing a hostile abdomen necessitates meticulous planning, adaptability, and interdisciplinary teamwork. Surgeons must navigate unpredictable intraoperative challenges while prioritizing patient safety and optimizing outcomes in this complex clinical entity.

Erythroderma, a dermatologic entity of an extensive and often challenging nature, emerges as a clinicopathologic enigma that requires a comprehensive understanding. This article stands as a comprehensive exploration of erythroderma, shedding light on its multiple clinical facets, underlying mechanisms, and treatment options. Through a meticulous synthesis of contemporary medical literature and paradigmatic case studies, it unravels the varied etiologic triggers that can precipitate this skin condition, including but not limited to inflammatory disorders, systemic infections, and underlying neoplasms. It delves into the polymorphic clinical presentations that characterize erythroderma, ranging from diffuse redness and exfoliative desquamation to intractable pruritus and water-electrolyte imbalances. In parallel, the spectrum of advanced diagnostic techniques comprising histopathology, imaging studies and molecular testing is explored, each playing a crucial role in determining the underlying etiology. In addition, therapeutic considerations are weighed in depth, evaluating targeted pharmacotherapy and supportive interventions to mitigate symptoms and address the underlying pathology. This article offers a holistic perspective aimed at illuminating the complexity of erythroderma, serving as an essential resource for clinicians, dermatologists, and healthcare professionals involved in the evaluation and management of this skin condition. Ultimately, it is postulated that a comprehensive appreciation of erythroderma, both in its clinical manifestations and pathophysiologic mechanisms, will lay the foundation for a more precise and personalized approach to its diagnosis and treatment in the contemporary medical landscape.

Background: Therapeutic relationship (TR) between nurses and patients is accepted as the cornerstone of caring. It is an interpersonal engagement aims to help patients to enhance their wellbeing through establishing a mutual trust relationship. Objective: To explore the therapeutic relationship between nurses and patients at tertiary level hospital in Bangladesh. Methods: Descriptive study was conducted among nurses and patients of Khulna Medical College Hospital. Sample was selected using convenient sampling technique and the sample size was 112 (56 nurses & 56 patients). Data were collected using structured questionnaire from the study participants. Questionnaire consists of two parts: Part I (For nurses), Part II (For patients). The descriptive statistics was used to organize the present socio-demographic characteristics of both nurses and patients. Inferential statistics including t-test, one way ANOVA was used to explore the relationship between nurses and patients socio-demographic characteristics and their perceived therapeutic relationship. Results: The total TR perceived by nurses was 44.52(SD=2.86) whereas patients was 16.55(SD=7.34) and there was significant difference (p=.00) between nurses and patients perceived TR. The results showed that there was a statistically significant difference in nurses perceived TR by their age category (t=2.46, p=.01) and there was a significant different in patients perceived TR and their living area (t= -5.61, p=.00). Conclusion: The study showed the therapeutic relationship perceived by nurses was high while the therapeutic relationship perceived by patients was low to moderate level.

Introduction: Vaccination is one of the main means of preventing influenza and reducing harm to the population. However, it should be noted that the COVID-19 epidemic may have influenced the drop in influenza vaccination coverage. Objective: This study aims to conduct a cross-sectional study on influenza vaccination in Brazil in 2022, characterizing by category, age group and clinical risk category by pathology. Material and Methods: The work was carried out in the form of a descriptive study with analysis of data obtained from the National Immunization Program Information System - SIPNI, Ministry of Health, Health Surveillance Secretariat and Executive Secretariat in the year 2022. Results: As shown in the results of this article, the total amount of influenza vaccines administered in 2022 was 62,918,552 million doses (80.72% of the vaccinated population), which is well below the 95% target set by the Ministry of Health and the World Health Organization. Final considerations: The good indicators of the past must be resumed, thus avoiding the return of infectious diseases that were once eradicated, or in the case of influenza, an increase in the number of deaths resulting from the disease.

Background: Quality of care is a core concern for health care organization. Quality of nursing care influences the outcomes and patient’ perception. Although patients’ perception is important indicator to measure the quality nursing care and patient’s satisfaction but it cannot be emphasized enough. Objective: This study objective was to explore the patients’ perception regarding quality of nursing care at tertiary level hospital in Bangladesh. Methods: A descriptive cross-sectional study design was carried out at Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2021 to June 2022. Study participants were conveniently selected comprising of sample size 120. Data were collected by face to face interview with structured questionnaire. Both descriptive and inferential statistics were used for data analysis. Results: The study finding revealed that the perceived quality of nursing care was 3.47±.68 indicated poor perception. There was statistically significant different between quality nursing care with gender (t= 3.02, p=.003), duration of hospital stays (r= -.271, p= .003), ward service type (t= 2.74, p=.007), and history of previous hospitalization (t= -2.21, p=.029). Conclusion: The quality nursing care was poor perceived by patients in Dhaka medical college hospital. There is a need to improve quality of nursing care to enhance patients’ perception.

Background: Ruptured ectopic pregnancy can cause life threatening hemorrhagic shock in females. Allogenic blood transfusion is limited in resource-constrained settings but autologous blood is readily available. This study reports a case series of autologous blood transfusions performed between September and November 2004 in an emergency hospital run by Doctors Without Borders in Monrovia, Liberia in West Africa during a period of civil war in the country. Methods: Out of a total 180 major surgery performed during that time, 16 were for ectopic pregnancy. After relevant history and examination, four quadrant aspiration of abdomen with 10 ml syringe was performed in suspected cases of ectopic pregnancy. Resistance free aspiration of blood in the syringe was taken as positive for intra-peritoneal hemorrhage and received immediate surgery. Blood was collected from the patients abdominal cavity with a bowl, filtered through 9 layers of gauze, packed into ACD bottles and transfused intra-operatively. Results: A minimum of 700 and maximum 2250 ml of blood was thus transfused. All patients survived the surgery with no operative or transfusion related complications and were discharged home within a few days. Conclusion: Autologous blood transfusion is a safe, simple and economic alternative to allogenic blood transfusion for surgeries, like ectopic pregnancy, in resource limited setting.

Hepatopulmonary syndrome (HPS) is one of the pulmonary complications from liver disease with or without cirrhosis. The prevalence of HPS varies from 4% to 47% in patients with liver cirrhosis. We present a case of chronic progressive dyspnea in an 18-year-old man with a history of chronic liver disease. Diagnosing can be particularly challenging, especially in cases involving prolonged dyspnea and comorbidities. Following thorough investigations, the patients condition was attributed to a rarer condition: severe hepatopulmonary syndrome. Contrast-enhanced echocardiography with agitated saline is the gold standard for diagnosing pulmonary vascular dilatation which is the hallmark of HPS. There is currently no medical therapy approved for HPS. Oxygen therapy is recommended for patients with severe hypoxemia.

Based on Blooms theory, dental caries can be influenced by four important factors that support the occurrence of caries, namely environment, behavior, health services, and heredity. Of these four factors, behavior plays an important role in dental and oral health. Research conducted by Afiati (2017) states that knowledge is the basis for the formation of behavior. This study generally aims to determine the Regression Analysis Level of Knowledge and Behavior of Parents in Cleaning the Teeth and Mouth of Children Aged 3-5 Years in KB and TK Sepuluh Nopember Surabaya. The type of research used is observational analytical research. The statistical test in this research is a regression test. In this study, the population taken was all KB and Kindergarten students in Sepuluh Nopember Surabaya in the 2022/2023 school year aged 3 to 5 years along with the parents and guardians of these students for a total of 58 students. This research is TKT 3 where to prove the hypothesis, in collecting data using primary data methods, namely giving questionnaires to the sample. It is hoped that this research can be a source of information on the importance of dental health knowledge on tooth cleaning behavior in children aged 3-5 years.

Background: Dental pain can be treated with analgesic medication. Patients who visit the dentist are generally prescribed analgesic drugs. Therefore, analgesics become therapy when patients experience pain. However, herbal plants are currently also widely used by the community to treat dental pain. This is because herbal plants have proven to be quite effective in treating various diseases. Purpose: To know how the level of knowledge of the community in utilizing herbal plants to treat dental pain. Methods: This type of research is descriptive with a cross sectional research design. This research was conducted from August to September 2022. The study population was the community in South Tangerang who filled out the questionnaire. Determination of the number of subjects is determined by the total sample, with snowball method. Conclusion: This research reveals that not all community are aware of the various types of herbal plants that can be used to treat dental pain.

Thyroid autoimmune disease is one of the most common disorders which are generally associated with existence of anti-thyroid peroxidase (TPO) in addition to ant thyroid stimulating hormone receptor (TSHR) antibodies, and anti-thyroglobulin (Tg). The present study was a cross-sectional one, conducted on (200) patients selected randomly from cases already diagnosed with thyroid disorder diseases by a specialized endocrinology center in AL-Basra city / Iraq. Where TPO test was performed for 127 of them, and TRAB test was conducted for the remaining 73 patients. The study showed that 74% of the cases that had a TPO test were positive, and 49% of the cases that had a TRAB test were also positive. The study also showed that the percentage of people with hypothyroidism was higher in those who had positive TPO results, in contrast to those who had positive TRAB results, where hyperthyroidism was the dominant disease.

In Al-Kut citys AL-Zahraa general hospital, this study was carried out.for individuals with liver cirrhosis to evaluate their serum levels of ALT, AST, GGT, ALP, urea, creatinine, T.Protien, Albumin, and Bilirubin. The 50 patients ranged in age from 20 to 60, with 29 male and 21 female individuals.Based on the patients medical history and physical examination, liver cirrhosis was determined to affect both sexes of the patient. The 30 control groups were drawn from the medical personnel and family of those who did not exhibit any indications or symptoms of renal liver disease or kidney diseases. With ages ranging from 22 to 66, there were 20 men and 10 women. Eight to fourteen hours following the patients overnight fasts, blood samples were obtained. The research reveals the following. Serum ALT, AST and GGT concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P<0.01).Serum Bilirubin (Total) and direct Bilirubin concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P<0.5), (P<0.01) respectively. Serum Albumin concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P>0.5). Serum Total protein concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P=0.5).Serum Alkaline phosphatase (ALP) concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P<0.01).Serum urea, creatinine, Uric acid and ammonia level concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P<0.01).

Background: Multivitamin administration in the periconceptional time was correlated with 16% decrement risk of premature deliveries. This study was aimed to investigate maternal and umbilical cord blood levels of zinc and copper in active labour versus elective caesarean. Patients and Methods: A case-control study was carried out in Salah Al-deen general hospital form February to September 2020. The study included full term pregnant ladies with active labour or prepared for elective caesarean attending the labour unit in Salah Al-deen general hospital. A total of 60 full term pregnant ladies divided into two groups consist of: (30) women in active vaginal delivery women, and group of (30) women prepared for elective caesarean section. Trace elements levels were evaluated utilizing the spectrophotometry. Results: The mean maternal serum zinc level among vaginal delivery group was (87.45±14.99) µg/dL versus (87.84±13.8) µg/dL among caesarean group. The mean umbilical zinc level among vaginal delivery group was (90.34±22.56) µg/dL and was higher among caesarean group (88.8±31.9) µg/dL. The mean maternal serum copper level among vaginal delivery group (83.82±14.02) µg/dL was lower than among caesarean group (127.57±37.23) µg/dL. Conclusion: There was higher mean umbilical cord zinc than the maternal zinc level. The mean umbilical cord zinc was lower than the maternal zinc among caesarean group. There was significantly lower mean umbilical cord copper than the maternal copper level among vaginal delivery group and the caesarean group. There was a positive significant correlation between maternal zinc level and umbilical zinc level. There was positive significant correlation between maternal copper level and umbilical copper level. Therefore, trace elements may play an essential function in the human parturition process.

Background: Despite being the second most frequent malignancy, lung cancer is the main reason for cancer-related fatalities. In this study, patients who underwent surgery for Non-Small Cell Lung Cancer and received adjuvant chemoradiotherapy will be evaluated. Patients and Methods: The data of 123 eligible patients who were operated with the diagnosis of Non-Small Cell Lung Cancer between 2000 and 2020 and who were treated with adjuvant chemoradiotherapy were retrospectively analyzed. Results: Of the 123 patients that were included in the study, 111 (90%) were males and 12 (10%) were females. The mean age was 62.11±8.92 (range:33-77) years. According to histological types, 65 (53%) patients were squamous cell carcinoma, 54 (44%) patients were adenocarcinoma and 4 (3%) patients were large cell carcinoma. Fifty-nine (48%) patients had undergone right lobectomy, 43 (35%) patients left lobectomy, 7 (6%) patients right pneumonectomy and 14 (11%) patients had left pneumonectomy. Mean OS time of all patients was 63.34±5.98 (51.62-75.07) months. One, 2, 3 and 5-year survival rates were 89.9%, 66.9%, 56.3% and 40.9%, respectively. There was a significant correlation between the T stage (p=0.05) of the disease and the chemotherapy protocol (p=0.046) and survival. Conclusion: Complete surgical resection remains the most effective treatment for patients with operable Non-Small Cell Lung Cancer. The high risks of distant recurrence brought on by the presence of metastatic disease that went unnoticed prior to surgery, however, restrict the effectiveness of surgical resection. Therefore, postoperative chemoradiotherapy employing constrained areas and contemporary approaches can be advantageous.

Acanthosis nigricans maligna (ANM) is a distinctive dermatologic entity presenting with cutaneous hyperpigmentation and epidermal thickening, characteristically located in flexural areas and skin folds. Despite its apparent cutaneous nature, ANM is frequently associated with underlying neoplastic conditions, implying profound clinical significance. In this study, we undertook a comprehensive evaluation of ANM from clinical, pathological and molecular perspectives with the aim of elucidating its etiopathogenic mechanisms and its relationship with neoplastic processes. From a clinical standpoint, we retrospectively analyzed a cohort of patients diagnosed with ANM, exploring the clinical and epidemiologic features that could indicate the presence of an underlying malignant condition. In addition, histopathologic studies were performed on samples of affected skin to discern the microscopic alterations associated with ANM and their correlates with neoplastic processes. In a molecular phase, an in-depth analysis of genetic and molecular markers in skin samples and associated tumor tissues was carried out using advanced sequencing techniques. This allowed the identification of specific mutations, chromosomal alterations and gene expression profiles that could contribute to both the occurrence of ANM and the promotion of the microenvironment conducive to tumor development. The results obtained indicate a significant correlation between the presence of ANM and the abnormal activation of cell signaling pathways, as well as the altered expression of regulatory factors of cell growth and differentiation. Our study highlights the importance of considering ANM as a potential cutaneous marker of underlying neoplastic processes and suggests that its early detection could facilitate the early identification of early stage malignant conditions. Taken together, this comprehensive analysis provides an in-depth view of ANM and its clinical, pathological and molecular relevance in the context of neoplastic diseases.

Nodular lepromatous leprosy, an atypical and advanced manifestation of lepromatous leprosy, constitutes a significant clinical and diagnostic challenge in the dermatologic disease landscape. In the present study, a comprehensive and multidimensional inquiry of this leprosy variant is undertaken to provide an enriched understanding of its clinical phenotype and underlying pathologic profile. This article is based on a prospective investigation involving a series of patients with nodular lepromatous leprosy, in which detailed clinical, histopathological and immunohistochemical analyses were performed. Through the integration of clinical findings with microscopic evaluations, the distinctive features of this nodular form are delineated, highlighting its diversified clinical presentation, which may include cutaneous nodules, peripheral nerve involvement and advanced systemic dissemination. Histopathological analysis highlights the diffuse infiltration of infected Schwann cells in the dermal nodules, as well as Langerhans cell hyperplasia and intense inflammatory response. In addition, immunohistochemical implications are explored, revealing increased expression of inflammatory markers and the involvement of immunomodulatory cells in the pathogenesis of the disease. Overall, this article seeks to fill the gap in the medical literature regarding nodular lepromatous leprosy by providing a comprehensive and up-to-date assessment of its clinical presentation and pathologic basis. The information derived from this study may not only enrich the current understanding of lepromatous leprosy as a whole, but also guide future research toward more precise and personalized therapeutic approaches for this particular clinical variant.

Incisional hernias are a frequent complication following abdominal surgery, with an incidence that varies depending on several factors. This comprehensive review explores the epidemiology, risk factors, complications, and management of incisional hernias. Understanding these aspects is crucial for healthcare professionals to provide effective care and reduce the burden of this condition on patients.

Combined dislocation and fracture of the upper cervical spine in adults is a rare condition that may result in devastating consequences. With the increase in road traffic accidents and the improvement in prehospital emergency care, serious injuries of the upper cervical spine are more frequently diagnosed at tertiary care centers. We report a case of a 19-year-old adolescent with dislocation-fracture of the upper cervical spine following a moderate-energy trauma. With early diagnosis and treatment, the patient showed good progress without major complications and 24-month follow-up.

Diabetic foot ulcers (DFUs) represent a significant health concern linked to poorly managed diabetes, affecting 19% to 34% of diabetic individuals and resulting in impaired functionality, infections, hospitalization, and the potential for amputations or mortality. Effective management involves addressing hyperglycemia, risk factors, and utilizing classification systems like SINBAD and IDSA/IWGDF for treatment. Skin grafting techniques such as split-thickness (STSG) and full-thickness (FTSG) grafts offer effective wound closure options. We acknowledged management for diabetic foot ulcers (DFUs) include autografts, cadaveric allografts, xenografts, and synthetic skin substitutes with natural polymers. Advanced techniques encompass biomaterials, nanobiomaterials, endothelial progenitor cells, and tissue engineering, while cellular therapies like mesenchymal stem cells (MSCs) show promise when properly activated. Innovations in DFU management encompass 3D bioprinting, nanotechnology, gene therapy, and photobiomodulation therapy. Positive clinical outcomes from skin grafting, including acellular fish skin (AFS) grafts, are observed, although challenges like graft rejection and limited technology awareness persist. Further research is essential to seamlessly integrate these advancements into DFU management for enhanced outcomes.

Background: Type 1 diabetes mellitus (T1DM) is an autoimmune condition caused by T lymphocytes that results in the death of pancreatic cells. Protein tyrosine phosphate non-receptor type 22 (PTPN22) and interleukin 2 receptor alpha (IL2RA) polymorphisms have been discovered to have a connection to a number of autoimmune illnesses, including T1D. Objective: The purpose of this study is to clarify the significance of the polymorphisms PTPN22 (rs2476601) and IL2RA (rs2104286) in the susceptibility to T1DM in young Iraqi children. Methods: The study included 60 Iraqi children diagnosed with T1DM within the past three years and a control group of 30 healthy individuals without diabetes or autoimmune diseases. In order to conduct a molecular investigation. Five ml of venous blood from 90 participants (60 patients and 30 controls) was collected for nucleic acid extraction. Results: The PTPN22 (rs2476601) and IL2RA (rs2104286) polymorphisms were genotyped using the amplification refractory mutation system (ARMS) technique and specific primers. According to the results, PTPN22 (rs2476601) has a wild-type homozygous C/C genotype and C allele frequency of 90%, a mutant C/T genotype frequency of 10%, and no T allele. Following were the genotype frequencies for IL2RA (rs2104286): AA, AG, and GG in T1DM patients were 79%, 16%, and 4%, respectively, compared to 83%, 13%, and 3% in controls. Conclusion: The polymorphisms of PTPN22 rs2476601 and IL2RA rs2104286 did not significantly differ in their connection with type 1 diabetes. It does not appear to affect the susceptibility of Asian Iraqis to T1D.

Introduction: Nutritional literacy is defined as the capacity of individuals to access, process and understand basic nutritional information. Although food and nutrition literacy plays an important role in the development of healthy eating behaviours, there are various factors that facilitate and complicate this situation. Objective: The aim of this study was to evaluate the nutritional literacy levels of individuals aged 60-64 years and their attitudes towards healthy nutrition. Materials and Method: The study is a descriptive and cross-sectional study. It was conducted in March-June 2022 in family health centres in the central district of Kütahya. The sample of the study consisted of 400 individuals aged 60-64 years living in the city centre of Kütahya. The descriptive Socio-demographic Characteristics Data Form consisting of 17 items, the Nutrition Literacy Assessment Tool for Adults (NLSA), and the Attitudes Towards Healthy Eating Scale (ATHS) were used to collect the data. The data were collected by the researcher using face-to-face interview technique. SPSS 25.0, a statistical package programme, was used for research analyses. Results: The mean score of the elderly on the scale of nutrition literacy in adults was 20.99±5.325. The mean scores of the sub-dimensions; general nutrition knowledge 6,37±1,887, reading comprehension 3,89±1,118, food groups 7,70±1,538, portion sizes 2,15±0,752, numerical literacy and food label reading 0,87±1,185. The mean score of the attitude scale of the elderly towards healthy nutrition was 71,86±12,85. The mean scores of the sub-dimensions are; knowledge about nutrition 16,61±4,616, emotion towards nutrition 16,79±4,606, positive nutrition 19,39±4,282, bad nutrition 19,08±4,53. It was determined that the scores of participants with normal weight from the scale of nutritional literacy in adults were higher than those of overweight participants. It was observed that there was a positive relationship between Nutrition Literacy in Adults and Attitude towards Healthy Nutrition at a normal level (r=0.528, p<.01). Conclusion: According to the Attitudes Towards Healthy Nutrition Scale, 61% of the elderly were found to have a high level of attitude towards nutrition. It was observed that 29% of the elderly included in the study had adequate nutritional literacy level and 70.3% of the individuals had limited nutritional literacy,

The knee is a joint made up of bones, muscles, ligaments and cartilage. The anterior cruciate ligament is a fundamental part for the proper functioning of the knee, being responsible for the stability of the joint, also being the main affected in ligament injuries of the knee. Most of these ligament injuries need to be treated surgically and after surgery, physiotherapeutic treatment is essential for the rehabilitation of the patient, aiming at a better return to their daily or sports activities. Several ways are found to assess whether an individual is fit or not to return to sport after an anterior cruciate ligament reconstruction surgery. Validated questionnaires are highly reliable and effective, proving to be very useful as a complementary way to assess the individuas discharge to return to sport. This study aimed to verify the evaluation of knee function in athletes and sportsmen undergoing reconstruction of the anterior cruciate ligament. The research is characterized as a descriptive, cross-sectional study with a quantitative and qualitative approach being applied through questionnaires in online format, prepared in Google Docs®. The study included a questionnaire with information on the participants profile, and two knee assessment questionnaires: the International Knee Documentation Committee (IKDC) Questionnaire for assessing symptoms, function and the degree of sports activity and the Previous Cruciate Ligament - Return questionnaire to Sport After Injury Scale (ACL-RSI) to assess the psychological impact of returning to sport after ACL reconstruction. The sample, composed of 23 volunteer participants, including 8 athletes and 15 sportsmen, obtained as results an average of 85% points in the IKDC questionnaire and 61% points in the ACL-RSI Brazil questionnaire for athletes and the results of 74% points in the IKDC questionnaire and 56% points in the ACL-RSI Brazil questionnaire for sportsmen. The psychological issue proved to be a greater difficulty for patients to return to sports, when compared to the functionality of a knee after reconstruction of the anterior cruciate ligament, which in turn, proved to be highly effective both in its surgery and in its post-operative and rehabilitation.

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

In Vitro Maturation (IVM) is one of the Assisted Reproductive Technologies (ART) that involves the retrieval of immature oocytes from antral follicles in the ovaries, either in a non-stimulated or minimally stimulated state. IVM has drawn the attention of fertility specialists due to its reliability, cost-effectiveness, low risk of Ovarian Hyperstimulation Syndrome (OHSS), and acceptable clinical pregnancy rates Objective: Understanding the Process and Factors Influencing In Vitro Maturation of Human Oocytes (IVM) Method: The research methodology employed in this study is the Systematic Literature Review (SLR) method. Data was collected by documenting all articles based on predetermined inclusion and exclusion criteria. A total of 10 national and international journal articles were utilized for this study, obtained from databases such as Google Scholar, PubMed, and Science Direct, using specific keywords including "In Vitro Maturation" and "human oocyte maturation". The literature search and study selection process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: There were no instances of moderate-severe OHSS (ovarian hyperstimulation syndrome) in the IVM group. The fertilization rate in the group receiving growth hormone (GH) was 12.8% higher compared to the control group. Additionally, the blastocyst rate in the GH group was 9.5% higher than that of the control group. Treatment with a concentration of 50 µmol/L ALA (alpha-lipoic acid) significantly accelerated oocyte maturation. It resulted in a significantly higher mitochondrial DNA (mtDNA) copy number in mature oocytes compared to the control group (0 µmol/L ALA). The highest maturation rates were observed in human umbilical cord mesenchymal cells (hUCM) in the in vitro maturation (fIVM) of germinal vesicle (GV) oocytes, while the lowest maturation rates were observed using alpha-Minimum Essential Medium (a-MEM) in the in vitro maturation (vIVM) of GV oocytes. When AMH (anti-Müllerian hormone) was added to the IVM medium, a maturation rate of 100% was achieved in mature oocytes. The inclusion of 50 mmol/L CoQ10 in IVM media was found to reduce the level of oocyte aneuploidy by nearly 50%. The formation rate of metaphase II (MII) stage oocytes was higher in culture medium containing 1.0 mm resveratrol compared to the control group. Subsequently, a total of eight cleavage-stage embryos were frozen after intracytoplasmic sperm injection (ICSI). One year later, when the patient returned for the transfer of cryopreserved embryos, two embryos were thawed and transferred into the uterus. The patient successfully became pregnant, and the twin pregnancy progressed without complications, delivering two healthy full-term baby boys. Conclusion: The occurrence of OHSS was not observed in any of the IVM intervention groups. Supplementation with growth hormone (GH), alpha-lipoic acid (ALA), umbilical cord-derived mesenchymal stem cells (CM-MSC), anti-Müllerian hormone (AMH), and resveratrol in the culture media each demonstrated a significant improvement in human oocyte maturation. Furthermore, resveratrol and coenzyme Q10 were effective in addressing abnormal spindle morphology, irregular chromosome arrangement, and high postmeiotic aneuploidy. It is worth noting that IVM is not exclusively limited to patients with polycystic ovary syndrome (PCOS), as it can yield satisfactory outcomes in patients with autoimmune premature ovarian insufficiency (POI).

Scalded skin syndrome, a rare but potentially serious dermatologic entity, stands as a clinical and scientific challenge in the contemporary medical field. This article proposes a comprehensive evaluation of this entity, covering clinical aspects, pathophysiological mechanisms and state-of-the-art therapeutic perspectives. The skin, as the most extensive organ of the human body, is prone to a diversity of pathologies, among which scalded skin syndrome emerges as a condition characterized by significant epidermal exfoliation, commonly evoked by staphylococcal exfoliative toxins. Despite its dramatic clinical presentation, its accurate diagnosis may require meticulous differential evaluation to discern it from other skin conditions with similar manifestations. From a pathophysiological perspective, cutaneous de-adhesion in scalded skin syndrome originates in the specific unbinding of intracellular adhesion molecules, leading to intraepidermal separation and ultimately intraepidermal blistering. The constantly evolving understanding of the molecular processes involved has led to innovative therapeutic approaches that go beyond mere suppression of the causative infection. In this comprehensive review, current and emerging therapeutic options are addressed, including intravenous immunoglobulin, immune response modulating agents, and therapies targeting dysfunctional molecular signaling cascades. In addition, the importance of supportive care and prevention of life-threatening complications, such as sepsis, is discussed. In summary, this article is intended as an essential resource for clinicians, researchers, and healthcare professionals interested in furthering the comprehensive understanding of scalded skin syndrome. The convergence of clinical, basic research, and advanced therapies is crucial to improve early detection, effective management, and prognostic outcomes in this complex dermatologic entity.

Curlings ulcer, also known as stress ulcer, represents a medical entity of considerable significance, characterized by the formation of ulcerative lesions in the gastric or duodenal mucosa in critically ill and traumatized patients. This condition, although infrequent, imposes a significant burden in terms of morbidity and mortality, due to its unpredictable clinical manifestations and its rapid and potentially unfavorable evolution. This article delves into the intricate pathophysiologic mechanisms underlying Curlings ulcer, highlighting the fundamental relationship with physiologic stress and hemodynamic alterations present in conditions such as extensive burns and severe trauma. The cascade of events culminating in mucosal barrier disruption, including tissue ischemia, exaggerated release of free radicals and proinflammatory cytokines, as well as imbalance in the production of gastroprotective prostaglandins, is comprehensively examined. The clinical manifestations and diagnostic challenges associated with Curlings ulcer are explored in detail, emphasizing the need for a high index of suspicion in critically ill patients to avoid delays in detection and treatment. Modern imaging techniques and endoscopic methods that facilitate accurate assessment of ulcerative lesions and their extent are described. In terms of therapeutic strategies, the medical and surgical approaches available to address Curlings ulcer are discussed in depth. The importance of hemodynamic support therapy and stress reduction in preventing ulcer formation is highlighted, as well as the benefits and risks of pharmacologic interventions aimed at mitigating inflammation and promoting mucosal healing are discussed. In addition, criteria for surgical intervention are discussed and guidelines for optimal procedure selection in specific clinical situations are provided. In summary, this article provides a comprehensive overview of Curlings ulcer, from its pathophysiological basis to its clinical implications and treatment options. A detailed understanding of this essential entity in the context of critical and critical care medicine is vital to improve early identification, effective management, and ultimately outcomes in affected patients.

Chest burns, a subset of burn injuries, pose unique challenges in terms of surgical management. This comprehensive review explores the epidemiology, risk factors, complications, and surgical management strategies for chest burns. A deep understanding of these aspects is crucial for healthcare providers to optimize patient outcomes and minimize the long-term consequences of chest burns.

The prevalence of bleeding complications after tooth extraction reached 31.5%. Hemostasis process is needed in this situation to avoid complications after tooth extraction. Kepok banana peel (Musa paradisiaca L.) is one of the traditional plants that can help the hemostatic process. Therefore, the purpose of this study was to determine the effect of giving kepok banana peel extract (Musa Paradisiaca L.) on bleeding time in cutting the tails of male mice, with the hope that in the future it can be used as an alternative for bleeding therapy after tooth extraction. Observations were made by taking 12 mice as samples and divided into three groups, namely the negative control group (K-), the positive control group (K+), and the treatment group (P). In the K- group, the mice were subjected to aquadest solution of 0.4 ml/20 mg BW, in the K+ group, tranexamic acid was probed at a dose of 0.065 mg/g BW mice as much as 0.4 ml/20 mg BW mice , and in the P group the kepok banana peel extract was probed with a dose of 1.55 mg/g BW mice as much as 0.4 ml/20 mg BW mice orally. All groups were cut on the tails of mice with a length of 0.5 cm. The cut wounds on the tails of mice were dripped onto absorbent paper boxes which were divided into 16 boxes, with an interval of 30 seconds in each box. The results showed that the administration of kepok banana peel extract (Musa Paradisiaca L.) had the effect of accelerating bleeding time on tail cutting of mice with BalB-C strain.

Background: Metabolic syndrome associated with indicators of inflammation such as C-Reactive Protein (CRP). Elevated CRP levels in obese adolescents is an indicator of metabolic disorders. Giving kencur extract to adolescents with metabolic disorders can reduce CRP levels. Increasing the acceptance of kencur in adolescents can be done by supplementing kencur extract in ice cream. The aim of the research was to obtain kencur extract supplementation ice cream products, with the best physical, chemical and organoleptic characteristics. It is hoped that this kencur extract ice cream can be used as an anti-inflammatory in obese adolescents. Research methods: The research design was Completely Randomized Design. There are 5 treatments of ice cream. Each treatment with a volume of 250 ml. The physical and chemical properties and organoleptic properties of kencur extract ice cream were observed. The statistical test used to determine differences in physical properties is ANOVA. While the test used to determine organoleptic differences is the Friedman test. Research result: All treatments had a pH of 7. Dissolved solids in ice cream ranged from 43.5% - 44.58%. The viscosity of ice cream ranges from 0.355 mN,m - 0.517mN,m. Ice cream overrun ranges from 110% - 168%. Ice cream melting speed ranges from 5.75 minutes - 8.975 minutes. The content of energy, protein, fat and carbohydrates. The more the addition of kencur extract the organoleptic properties of ice cream, the less preferred it is. Conclusion: Ice cream with high acceptability is one added with 2700 mg of kencur extract and 2900 mg of kencur extract.

Background: High-Dose-Rate Intracavitary Brachytherapy (HDR-ICBT) is a commonly employed treatment modality for cervical cancer, delivering a high dose of radiation directly to the tumor site while minimizing exposure to surrounding healthy tissues. Anaesthesia administration during HDR-ICBT varies, with some centres using Sedation (CS) and others employing General Anaesthesia (GA). Despite the widespread use of these anaesthesia techniques, their potential impact on dosimetric outcomes, particularly in the urinary bladder and rectum, remains an area of interest and investigation. Objective: This study aimed to determine the dosimetric difference in the urinary bladder and rectum doses among cervical cancer patients undergoing HDR-ICBT under CS and GA. The study was conducted at Bugando Cancer Centre (BCC) and Ocean Road Cancer Institute (ORCI) to compare the dosimetric outcomes between the two anaesthesia techniques. Methods: A total of 273 patients who underwent HDR-ICBT for cervical cancer were included in the study. Patients were divided into two groups based on the anaesthesia technique used during the procedure: 143 patients received GA, and 130 patients received CS. Dosimetric parameters of the urinary bladder and rectum doses were collected and analysed using descriptive statistics and the independent samples t-test. Results: The findings demonstrated a statistically significant dosimetric difference in the mean urinary bladder dose between patients treated under GA and CS (p < 0.001). Patients under GA received a significantly lower mean urinary bladder dose compared to those under CS. However, no statistically significant difference was observed in the mean rectum dose between the two anaesthesia groups (p = 0.689). Conclusion: The study reveals that the choice of anesthesia technique significantly impacts the urinary bladder dose during HDR-ICBT for cervical cancer. Patients receiving GA had a lower mean urinary bladder dose compared to those under CS. However, no significant dosimetric difference was observed in the mean rectum dose between the two anesthesia groups. These findings emphasize the importance of considering anesthesia techniques during treatment planning to optimize dosimetric outcomes and patient safety in HDR-ICBT. Further investigation and long-term follow-up are warranted to validate and expand upon these results. Collaboration between radiation oncologists and anesthesia teams is crucial to enhance treatment efficacy and minimize potential complications during HDR-ICBT for cervical cancer

Stiff Skin Syndrome, also known as "diffuse stiff skin syndrome" or "Scleroderma-like syndrome with focal contracture", is a rare and complex clinical entity in the spectrum of connective tissue diseases. This disorder is characterized by progressive and diffuse infiltration of connective tissue into the skin and underlying tissues, resulting in extreme skin stiffness and limited joint mobility. In addition to its cutaneous and joint manifestations, stiff skin syndrome can affect multiple internal organs, making it a clinical entity of great multidisciplinary relevance. This article aims to provide a comprehensive review of stiff skin syndrome, addressing its epidemiology, clinical manifestations, etiopathogenesis, differential diagnosis, and current therapeutic options. Recent research that has shed light on the underlying molecular mechanisms and emerging therapies that are being developed to improve the quality of life of patients affected by this disease are highlighted. In addition, the importance of a comprehensive evaluation and an interdisciplinary therapeutic approach to optimize the clinical management of individuals with rigid skin syndrome is highlighted.

Pseudoaneurysm is defined as a vascular anomaly generated by the interruption of the arterial wall, which conditions accumulation and persistent confinement of blood. The incidence of pseudoaneurysm ranges between 0.2%-0.5% in diagnostic interventional techniques and up to 6% in therapeutic techniques, however, despite its low incidence, complications are potentially severe. We present 3 cases of pseudoaneurysm in the peripheral vasculature after percutaneous interventions, as well as the description of the diagnostic challenge and the assessment by the different imaging methods. This case report article shows the diagnostic approach through the different imaging methods, as well as a brief review of the subject with a focus on the role of the interventional radiologist.

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Multifocal osteonecrosis is a rare entity and is defined by the involvement of at least three different territories. It mainly affects young people between the second and fifth decade of life. We present the clinical case of a patient who presented multifocal osteonecrosis with involvement of both hips, shoulders, knees, right elbow, and neck of the left foot. The main risk factor present in this case is the consumption of glucocorticoids. It required a multidisciplinary approach for both diagnosis and treatment.

Purpose: In an effort to lower the number of falls that occur among hospitalized patients, several facilities have begun introducing various fall prevention programs. However, the efficacy of fall prevention programs is diminished if patients do not consider themselves to be at risk for falls and do not follow recommended procedures. The goal of this study was to characterize how patients in four different acute care specialist services felt about their risk of falling while in the hospital. Methods: One hundred patients admitted to the study hospital with a Morse Fall Scale score of 45 or higher were given the Patient Perception Questionnaire, a tool designed to assess a patients perception of their own fall risk, fear of falling, and motivation to take part in fall prevention efforts. Scores on the Morse Fall Scale were gathered through a historical assessment of medical records. Descriptive statistics, Pearsons correlation coefficients, and independent sample t tests were used to examine the data. Results: The average age was 65, and around half (52%) were men and half (48%) were women. Based on their ratings on the Morse Fall Scale, all 100 participants were classified as being at high risk for falls. However, only 55.5% of the individuals agreed with this assessment. The likelihood that a patient would seek assistance and the degree to which they feared falling both declined as their faith in their mobility improved. Patients hospitalized after a fall exhibited considerably lower confidence scores and greater fear scores than patients who had not been injured in a fall. Conclusions: Patients who have a high fall risk assessment score may not believe they are at risk for falls and may not take any steps to reduce their risk. The prevalence of falls in hospitals might be mitigated by the creation of a fall risk assessment technique that takes into account both objective and subjective factors.

Laparoscopic cholecystectomy is a widely performed surgical procedure for the treatment of gallbladder-related conditions. While it is considered a safe and effective approach, it is not without complications. This comprehensive review explores the epidemiology, risk factors, complications, and management of complications associated with laparoscopic cholecystectomy. A thorough understanding of these aspects is crucial for healthcare providers to optimize patient outcomes and ensure the safe delivery of this common surgical procedure

Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure for disorders of the biliary and pancreatic ducts. While ERCP is generally safe and effective, it is not without complications. This comprehensive review explores the epidemiology, risk factors, complications, and management of complications associated with ERCP. A thorough understanding of these aspects is essential for healthcare providers to optimize patient outcomes and ensure the safe delivery of this important procedure.

Tuberculosis is an infectious disease chronic Which caused by Mycobacterium tuberculosis. Objective study: To analyze related factors _ with BTA positive conversion on Pulmonary TB sufferers at the Community Health Center Biau Regency Buol. The study was implemented in the Work Area Public Health Center Biau Regency Buol. Sample in study This is sufferers of Tuberculosis undergoing lung _ treatment. The study takes place with a selection of 45 people. Research This is analytical survey research with a design. Population is the whole object to be researched. Population in study This is all pulmonary TB sufferers undergoing treatment for more than 2 months; the sample study totaled 45 people using the total sampling technique. Results findings show A relationship between treatment adherence and BTA-positive conversion in tuberculosis sufferers with p-value = 0.044. There is a relationship between family support and BTA-positive conversion in tuberculosis sufferers with a p-value = 0.001. There is no relationship between support from health workers and BTA positive conversion in tuberculosis sufferers with p-value = 0.581, there is a relationship between knowledge and BTA Positive conversion in tuberculosis sufferers with p-value = 0.000, there is a relationship between access to health services and BTA positive conversion in tuberculosis sufferers with p-value = 0.035, there is no relationship between preventive behavior and positive BTA conversion in tuberculosis sufferers at Biau Community Health Center, Buol Regency with p-value = 0.561. This study concludes that family support has a risk of 66,442 times the incidence of BTA-positive conversion in pulmonary TB sufferers.

Surgical site infections (SSIs) continue to be a significant concern in surgical practice. This comprehensive review explores the epidemiology, risk factors, complications, and management of SSIs. A deep understanding of these predisposing factors is crucial for healthcare providers to implement effective preventive measures and minimize the impact of SSIs on patient outcomes