Background: Palliative care is about achieving the highest quality of life and promoting comfort and dignity for patients with incurable and life-limiting diseases. End-of-life care is one of the routine activities of nurses. Objective: The study was aimed to assess the level of knowledge and practice of nurses in palliative care in tertiary hospitals. Methodology: A descriptive cross-sectional study was conducted. A total number of 308 nurses were selected following defined selection criteria. The purposive sampling method was applied for data collection. Data were collected from Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, National Institute of Cancer Research and Hospital. Results: This study showed that among the total respondents, 58.4% had average knowledge 27.3% had good knowledge, 14.3% had poor knowledge of palliative care, 57.5% had moderate practice, 28.5% had adequate practice and 14.0 % had inadequate practice on palliative care. Conclusion: This study found that nurses knowledge and practice of palliative care were not satisfactory and they need palliative care training. Therefore, upgrading nursing education and palliative care training sessions will be improved for nurses to deal with terminally ill patients.

Endometrial cancer is one of the main gynecological cancers worldwide, risk factors play a very important role, and very recently it has been associated with obesity. There is a classification with 7 different types of endometrial tumor. Hysterectomy continues to be the primary treatment in patients with endometrial cancer, adjuvant treatment depends on the stage and prognosis of the patient.

Polycystic kidney disease (PKD) is a heterogeneous, inherited clinical entity characterized by the formation of renal cysts, which can manifest with a wide range of symptoms and complications. This article comprehensively reviews advances in the diagnosis and treatment of PKD, highlighting the importance of a multidisciplinary approach ranging from primary care to specialized care in nephrology and urology. Management strategies for major symptoms such as low back pain, hypertension, and urologic complications are discussed, as well as the most recent therapeutic options, including vasopressin inhibitors and ongoing clinical trials. Furthermore, it highlights the relevance of patient education and early detection in the management of this pathology, in order to improve the quality of life and survival of patients with PKD. This article provides a comprehensive overview of the management of PKD, with a focus on the latest research and therapies, to guide health care professionals in making informed clinical decisions and providing patients with high-quality care in the context of this complex renal disease.

Background: The study is aimed to evaluate the association between raised serum Homocysteine levels and severity of Peripheral Vascular Disease (PVD) and its role as a prognostic marker in PVD. Thereby, Vitamin K therapy can be instituted for lowering Homocysteine levels as prophylaxis against cerebral and coronary events in PVD patients. Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the abovevalues with Doppler ultrasonography (USG) in the duration between 2020-2022(18 months) Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum homocysteine levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 80% predictability. Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomized trials are required to elucidate its clinical relevance in PAD as a prognostic marker of Severity.

Post-operative wound infections are a pressing concern in surgical wards, contributing to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. This study investigates the prevalence and risk factors of postoperative wound infections in the surgical wards of Rajshahi Medical College Hospital in Bangladesh. A cross-sectional design was employed, encompassing 300 participants who underwent surgical procedures at the hospital. Structured questionnaires and observational techniques were used to collect data on demographic attributes, hand hygiene practices, dressing techniques, sterilization procedures, environmental cleanliness, and patient-related elements. The study revealed that among the participants, 135 (45.0%) practiced hand washing before dressing, while 198 (66.0%) practiced hand washing after dressing. The dressing technique of the doctor or nurse was perceived as proper by 154 participants (51.3%), while 174 (58.0%) reported that dressing materials were sterilized. Moreover, 183 participants (61.0%) perceived the bed sheets to be clean, while 161 (53.7%) considered the cleanliness of the patients dress to be satisfactory. Additionally, 196 participants (65.3%) reported that the instruments used were sterilized, and 191 (63.7%) found the arrangement of the trolley to be proper. Statistical analyses were performed to assess relationships between variables. No significant relationship was found between educational status and cleanliness of bed sheets (?² = 0.41, df = 3, p > 0.05), or between educational status and cleanliness of the patients dress (?² = 10.38, df = 3, p > 0.05). These results suggest that educational status may not significantly impact these aspects of infection control. The study underscores the complex nature of postoperative wound infections and infection control practices. Findings align with previous research on surgical site infections (SSIs) and emphasize the importance of standardized protocols, consistent surveillance, and context-specific interventions. The studys contributions offer valuable insights for optimizing infection control strategies in similar healthcare settings. Through the implementation of recommended strategies, Rajshahi Medical College Hospital and other healthcare institutions can enhance infection control practices, ultimately leading to improved patient outcomes and reduced rates of post-operative wound infections.

Common bile duct cysts are a rare medical condition, which is characterized by dilation of the intrahepatic and extrahepatic bile ducts. The main clinical presentation is abdominal pain, jaundice and a palpable abdominal mass. They are premalignant lesions, so the treatment of choice is complete surgical resection with long-term follow-up. The following report relates a male adolescent treated surgically with good results.

Gorlin-Goltz syndrome, also known as basal cell nevus syndrome or nevoid basal cell carcinoma syndrome, is a rare and heterogeneous genetic disease with a varied clinical presentation involving multiple systems and organs. This comprehensive review aims to provide an in-depth understanding of this syndrome from a medical and scientific perspective. Gorlin-Goltz syndrome is characterized by an inherited predisposition to the formation of skin and skeletal tumors, as well as the development of jaw cysts, cleft palates, facial deformities, ocular malformations and other anomalies. At the genetic level, this syndrome is linked to mutations in the PTCH1 gene, which regulates the hedgehog signaling pathway, playing a crucial role in the regulation of cell growth and differentiation. Early and accurate diagnosis of Gorlin-Goltz syndrome is essential to prevent serious complications, such as advanced basal cell carcinomas and facial disfigurement. Molecular diagnostic strategies and therapeutic options, including reconstructive surgery, hedgehog pathway inhibitor therapy, and multidisciplinary patient management will be addressed. This review will also explore the psychological and social impact on patients and their families, as well as advances in genetic and therapeutic research that may open new perspectives for the management and prevention of this complex disease. Ultimately, detailed knowledge of Gorlin-Goltz syndrome is essential to improve the quality of life of those affected and to promote future research in this evolving field.

Umbilical Hernias are those ventral type hernias, and can be located within the umbilicus or in its surroundings, according to “The European Hernia Society “classifications, a hernia can be defined as an umbilical hernia when is located 3 cm above and 3cm below the umbilicus. In order to classify hernias, they have to be divided into 3 types: Omphalocele and gastroschisis, infant umbilical hernias and acquired umbilical hernias. The diagnosis of the patients with umbilical hernias must be correlated with the clinic, although these patients generally are asymptomatic and do not display any other complications besides from an esthetic defect. If the clinical diagnosis is very complicated, image studies may be required as an abdominal ultrasound, tomography or a magnetic resonance. The umbilical hernia treatment can be expectant, open surgery or laparoscopic surgery, depending on the characteristics of the affected patient or the umbilical hernia.

Atopic dermatitis, a chronic inflammatory skin disease of a predominantly genetic nature, has attracted continued interest in the field of dermatology and immunology due to its pathophysiological complexity and its significant impact on patients quality of life. In this article, we present a comprehensive review of the current literature on atopic dermatitis, addressing its clinical characterization from a holistic perspective and the underlying pathophysiologic mechanisms that define it. From a clinical point of view, the heterogeneity of cutaneous manifestations in atopic dermatitis is highlighted, including erythema, intense pruritus, lichenification and exudation. In addition, the variability of clinical presentations throughout the different stages of life is explored, focusing on early childhood and adulthood, which underlines the need for a multidisciplinary and personalized approach to its management. In terms of pathophysiological mechanisms, the dysfunction of the skin barrier, the dysregulated immune response and the involvement of key cytokines in the perpetuation of the inflammatory process are examined in detail. The interaction between genetic and environmental factors in the development and exacerbation of the disease is discussed, as well as the connection between atopic dermatitis and other atopic conditions, such as asthma and allergic rhinitis. In addition, conventional and emerging therapies for atopic dermatitis, including topical corticosteroids, calcineurin inhibitors, biologic therapies, and approaches aimed at modulating the skin microbiota, are discussed. The importance of patient education, skin care strategies and a comprehensive approach to achieve effective symptom control and prevent recurrences is emphasized. In summary, this article provides a comprehensive view of atopic dermatitis, merging its clinical and pathophysiological aspects. Advanced understanding of the clinical diversity and underlying mechanisms is crucial for an informed and optimal management of this constantly evolving chronic skin condition.

Introduction: Diverticular disease of the colon is an increasingly common condition in developed countries. Diverticula can develop in any segment of the colon, but are more common on the left side. The prevalence of cecal diverticula in Western countries is 1-2%, while in the East it represents 43-50% of colonic diverticula. Furthermore, in the West, the majority are solitary. When they are solitary, they are generally congenital and true, and if they are multiple, they are typically false (pseudodiverticula) and acquired. Clinical case: 50-year-old female, administrative employee, with a history of systemic arterial hypertension and mixed dyslipidemia; that she presented to the emergency medical service reporting anorexia, generalized abdominal pain, fever of 38.2 °C on one occasion and in the absence of alterations in fecal evacuations. On physical examination, the abdomen was presented with decreased peristalsis, slightly tympanic on percussion, painful on palpation in the left iliac fossa with involuntary muscular resistance. An abdominal mass was also palpated in the left iliac fossa. Additionally, he reported mild pain on palpation in the iliac fossa. right, doubtful Mc Burney sign, negative rebound. During his hospitalization, laboratory studies were performed, which reported leukocytosis, neutrophilia and thrombocytopenia, in addition to a simple and contrasted abdominopelvic tomography which reported multiple diverticular formations in the descending and sigmoid colon, which were accompanied by striation of the pericolic fat, with fluid. free in the left slide, pelvic and perihepatic cavity, with gas particles in the slide, thickening and increased enhancement of the walls of the descending colon and sigmoid. Discussion. Right-sided diverticulitis is a rare disease in the West, accounting for 1 to 3.6% of total cases of diverticular disease. Approximately 80% of right-sided diverticula are located on the anterior surface of the cecum, close to the ileocecal valve, and are usually asymptomatic.

Infective endocarditis on valve prostheses accounts for 10-30% of all cases of endocarditis, with an in-hospital mortality of 20-40%. It is present in approximately 1-6%4 of patients with valve prostheses, with an incidence of 0.3-1.2% of patients per year. We present the case of a patient who underwent his third sternotomy secondary to acute heart failure due to dysfunction of the mechanical prosthesis, rupture of the annulus and severe paravalvular leak.

Sepsis remains a significant concern in the context of abdominal surgery, often culminating in septic shock—an acute, life-threatening condition. This comprehensive review explores the epidemiology, risk factors, complications, and management of septic shock in the aftermath of abdominal surgery. Understanding these aspects is essential for healthcare providers to optimize patient outcomes and ensure the safe delivery of surgical interventions.

Introduction: In certain emergency situations, a patient admitted to a hospital with fewer resources needs to be transferred quickly to a unit better prepared to deal with them. This is when the aeromedical transport service is needed. For this, the aircraft must be staffed by specialized health professionals and have a variety of resources to provide the best care for the patient. Objectives: 1) The general objective of this article was to analyze changes in intracranial pressure (ICP) in Brazilian Air Force pilots undergoing a level straight flight. 2) To help collect data for the development of a non-invasive sensor for monitoring ICP in flight. 3). To verify whether the equipment for measuring non-invasive Intracranial Pressure can be used in air ICUs. Materials and Methods: The work evaluated the presence of morphological changes in non-invasive ICP during level straight flight lasting 30 min among 10 (ten) pilots who volunteered for the collection. Results: It was observed that the ICP pulse waveform did not change during straight level flight, when compared to normal resting situations of an individual in a collection in a terrestrial environment, demonstrating the reliability of the equipment and the research. Final considerations: This study has helped to understand not only the need for rapid diagnosis of non-invasive ICP, but also the possible suitability of this equipment in aircraft prepared for rapid diagnosis and tratament.

Ogilvie Syndrome, also known as acute colonic pseudo-obstruction, is a rare but clinically significant gastrointestinal disorder characterized by marked colonic dilation in the absence of mechanical obstruction. This condition often presents with abdominal distension, discomfort, and obstipation, leading to substantial morbidity and mortality if not promptly recognized and managed. Despite its infrequent occurrence, Ogilvie Syndrome poses a diagnostic and therapeutic challenge to healthcare providers. This comprehensive review aims to elucidate the pathophysiological mechanisms underpinning this syndrome, detail the diverse clinical manifestations, and discuss the evolving strategies for diagnosis and management. With a focus on the latest advancements in medical and interventional therapies, this article provides a comprehensive overview of Ogilvie Syndrome, equipping clinicians with essential knowledge to improve patient outcomes.

Flexor tendon injuries of the hand represent a challenging clinical entity with significant functional implications. This comprehensive article delves into the intricate realm of flexor tendon injuries, shedding light on the pathophysiology, diagnostic approaches, and treatment modalities, with a primary focus on the surgical technique of tendinorrhaphy. The article commences with an exploration of the anatomy and biomechanics of flexor tendons, elucidating the pivotal role they play in hand function. It subsequently outlines the diverse etiologies that lead to tendon injuries, encompassing traumatic, iatrogenic, and spontaneous causes, while emphasizing the importance of prompt and accurate diagnosis through clinical assessment, imaging, and functional testing. A detailed exposition of the principles and techniques of tendinorrhaphy follows, elucidating the surgical intricacies involved in repairing damaged flexor tendons. The article discusses suture materials, repair methods, and rehabilitation protocols, highlighting the importance of postoperative care and meticulous hand therapy in optimizing outcomes. Furthermore, this article critically reviews emerging trends and innovations in the field, including the use of tissue engineering, biomaterials, and minimally invasive approaches, all of which hold promise for enhancing the management of flexor tendon injuries. In conclusion, this article offers a comprehensive overview of flexor tendon injuries in the hand and underscores the pivotal role of tendinorrhaphy as a cornerstone in their treatment. With a holistic perspective on the subject, it provides clinicians and researchers with a valuable resource to navigate the intricacies of this challenging clinical scenario and fosters ongoing advancements in the field of hand surgery.

Dacryostenosis, a chronic ophthalmologic condition characterized by partial or total obstruction of the lacrimal drainage system, has been the subject of in-depth scrutiny in the medical literature. This article aims to comprehensively investigate dacryostenosis from a clinical and surgical perspective, providing a comprehensive analysis of its etiology, clinical manifestations, and available treatment options. Through a critical review of the current literature and presentation of data from a prospective cohort of patients, we explore state-of-the-art diagnostic modalities, such as magnetic resonance dacryocystography and optical coherence tomography, which have revolutionized the evaluation of dacryostenosis. Regarding surgical management, traditional techniques, such as dacryocystorhinostomy, are discussed, together with the latest innovations, such as endoscopic dacryoplasty and intranasal balloon dilatation. A detailed comparison of the advantages and disadvantages of these techniques is presented, along with their success rates and associated complications. Finally, long-term outcomes are examined, including improvement in patients quality of life, symptom reduction, and durability of surgical interventions. This article provides a comprehensive view of dacryostenosis, highlighting the importance of a multidisciplinary approach to its management and the pivotal role of surgery in restoring tear function and ocular well-being.

Penile artery occlusion is a vascular condition that can lead to erectile dysfunction, significantly affecting a patients quality of life and psychological well-being. This comprehensive review explores the epidemiology and clinical significance of penile artery occlusion, emphasizing the substantial impact it has on patients sexual health. The theoretical framework delves into the definition of penile artery occlusion, identifies risk factors contributing to its development, discusses potential complications, and outlines current management strategies. The discussion section evaluates the use of phosphodiesterase inhibitors as a therapeutic approach in patients with penile artery occlusion, providing insights into their mechanisms of action, efficacy, and safety. The conclusion emphasizes the importance of a personalized approach to managing this condition, with phosphodiesterase inhibitors as a valuable option.

Cardiogenic shock is a life-threatening condition characterized by severe cardiac dysfunction and hemodynamic instability. The choice of inotropic agent for managing cardiogenic shock is a critical decision for healthcare providers. This comprehensive review assesses the use of levosimendan and dopamine in the management of cardiogenic shock. It explores the epidemiology of cardiogenic shock, the significance of this clinical challenge, and the theoretical framework of inotropic support. Furthermore, it examines risk factors, potential complications, and optimal management strategies. The discussion delves into the comparative efficacy and safety profiles of levosimendan and dopamine, providing insights into their roles in this critical clinical scenario. Finally, the review concludes with a summary of key findings and recommendations for clinical practice.

Patient care and quality management have as one of their primary focuses ensuring the safety of their patients. The four principles of biomedical ethics presented by Beauchamp and Childress are one quality management paradigm that emphasizes the importance of the patient. The Institute of Medicines six improvement goals capture the essence of excellent medical treatment. Care, money, and health are the three pillars upon which the Institute for Healthcare Improvements Triple Aim rests. The present review was written with the aforementioned contexts in mind, with the intention of highlighting the systems initiatives to address various efforts of enhancing quality and patient safety. We provide a reflective overview of healthcare legislation, policy, and regulation with special attention paid to the ideas of informed consent and informed refusal. This analysis also details the steps taken and regulations enforced by the administration and management to provide care that is focused on the individual patient. Finally, we discuss model policies like the Delivery System Reform Incentive Payment Program, which incorporates quality management frameworks, the Hospital-Acquired Conditions Reduction Program, which promotes patient safety, and the Hospital Readmissions Reduction Program, which aims to reduce hospital readmissions.

Introduction: Diabetic ulcers, common complications of poorly managed diabetes mellitus, significantly impact physical well-being, afflicting 25% of diabetes patients. We conducted a retrospective study at Margono Soekarjo County Hospital in Indonesia to comprehensively describe demographic and clinical characteristics, aiming to inform prevention, management, and patient-centered care strategies. Methods: Using secondary data and a cross-sectional approach, we collected information from inpatients with diabetic ulcers at Margono Soekarjo County Hospital in 2020-2021, profiling age, gender, education, occupation, blood sugar levels, and ulcer sites. Results: Most inpatients were female (56.1%), aged over 60 (46.1%), with primary school education (33.9%). The majority had blood glucose levels >200 mg/dl (58.6%), and foot ulcers were predominant (91.8%). Discussion: Diabetic ulcers, affecting 25% of diabetes patients, result from poorly managed diabetes and significantly impact physical well-being. Our findings align with global trends, highlighting disparities in education and employment that affect healthcare access. Conclusion: Addressing these disparities and improving blood glucose management is crucial to mitigate the diabetes burden. Our study underscores the need for tailored public health strategies in Indonesia with potential global relevance

Introduction: Enteric fever is a severe systemic disease caused by a gram-negative bacillus, Salmonella Enterica serotype Typhi. It commonly occurs in children and young adults. The aim of the research is to address the treatment of enteric fever in pediatric patients including multidrug resistance to first-line drugs. The treatment of enteric fever has been complicated by the worldwide spread of typhoid organisms resistant to ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol. Ceftriaxone damages the germ structure that can kill Salmonella typhi, germ resistance is limited and there are no harmful side effects when administered to children. Discussion: The interest in this pathogen is based on Salmonella typhi strains that have become multiresistant to antibiotics such as some cephalosporins, fluoroquinolones, etc. The importance in terms of antimicrobial resistance lies in the failure of conventional treatments, which causes a delay in effective therapeutic management. Conclusion: Cephalosporins are currently the first line against enteric fever, specifically ceftriaxone and cefixime. In order for the treatment to conclude satisfactorily, it is necessary to observe the disappearance of fever and the decrease of accompanying symptoms.

Introduction: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is widely used to treat pain and inflammation. However, diclofenac use has been associated with a number of side effects, including renal toxicity. The mechanisms underlying diclofenac-induced nephrotoxicity are not fully understood, but oxidative stress and inflammation are thought to play a role. This study investigated the effects of diclofenac on renal antioxidants and cytokines in male Wistar rats. Method: Male Wistar rats were randomly divided into three groups: control group, low and high-dose diclofenac group (10 and 30 mg/kg/day) respectively. Treatment was administered for 10 days. At the end of the study, the rats were sacrificed, serum samples and kidney homogenates were analysed for markers of oxidative stress, lipid peroxidation and inflammation including assessment of renal function. Result: Diclofenac treatment caused a significant decrease in renal antioxidants, including superoxide dismutase (SOD) and glutathione peroxidase (GPx) compared to the control, (0.78±0.11 versus 0.61±0.14), (214.80±46.37versus 149.70±39.43) P <0.05 respectively. In addition, a significant increase in the level of MDA and renal cytokine (TNF-a) was observed between the control and treated group of rats (2.62±0.29 versus 8.74±4.34, p<0.001) and (1276.0±90.18 versus 222.90±38, P=<0.00) and respectively. The high-dose diclofenac caused a significant increase between the treated and control group of rats respectively and deranged renal function test (serum creatinine and renal KIM-1) Conclusion: This study provides evidence that diclofenac may induce alterations in renal antioxidants, and mediates oxidative stress and inflammation with consequent kidney injury in male Wistar rats.

Keloid scars are a challenging dermatological condition characterized by excessive scar tissue formation beyond the boundaries of the original wound. This review explores the epidemiology and clinical significance of keloid scars, emphasizing the substantial impact they have on patients quality of life and psychosocial well-being. The theoretical framework delves into the definition of keloid scars, identifies risk factors contributing to their development, discusses potential complications, and outlines current management strategies. The discussion section evaluates the role of radiotherapy in managing keloid scars, providing insights into its mechanisms of action, efficacy, and safety. The conclusion emphasizes the importance of a personalized approach to keloid scar management, with radiotherapy as a valuable therapeutic option.

Icthyosis vulgaris, a rare hereditary skin disorder, poses a significant clinical challenge due to its complex pathogenesis and clinical variability. This comprehensive review aims to provide an in-depth understanding of the underlying pathophysiological aspects of ichthyosis vulgaris, with a focus on the X-linked variant (X-Linked Ichthyosis, XLI). We will discuss the genetic foundations, molecular mechanisms involved in skin barrier dysfunction, and the characteristic clinical presentation of this condition. Furthermore, current and emerging treatment options, including pharmacological therapies and gene therapy, will be reviewed, highlighting the latest advancements in ichthyosis vulgaris research. This review will offer crucial insights for clinicians, geneticists, and scientists interested in comprehending and managing this hereditary skin disorder.

Irritable bowel syndrome (IBS) is a very common medical condition amongst the Mexican adult population, this chronic syndrome is characterized by abdominal pain and changes in bowel habits. The ability to identify a definitive etiology of this disease would not only help us to improve the treatment, it would also enable the possibility to prevent it. This is why the main objective of this article is just that, finding the cause and linking it with dietetic management and nutritional intervention. There is a bidirectional communication between the central nervous system and the gastro-intestinal tract (brain-intestine axis), this axis is made up from afferent fibers to integrate impulses in the central nervous system and efferent fibers to control smooth muscle, as well as glands and neuroendocrine cells. This communication permits the brain to have direct influence over the intestine, and therefore change bowel habits based on alterations in the brain chemistry such as stress or other strong emotions. Describing a single cause for IBS would be incorrect since there are multiple causes that might be happening simultaneously. Some of them are: infection, immune response, food intolerance, genetics and the psychological factors that were previously mentioned. It is not possible to talk about IBS without considering diet. Most patients with IBS report an intolerance to certain food from the mexican diet, such as lactose, legumes, oligosaccharides, monosaccharides and polioles this group is known as FODMAP, and they share three main characteristics that are associated with developing symptoms: they have osmotic activity, are poorly absorbed and also are fermented by the microbiome.In conclusion the are multiple etiologies for irritable bowel syndrome, that may or may not be simultaneously happening in a single person.

Objective: This study was carried out to evaluate the effectiveness of pain self-management support intervention on pain and its interference with daily activities among patients with cancer in Vinh Phuc Province after 1 week of discharge from the hospital. Methods: A randomized controlled clinical trial was used. The study was conducted on 116 patients with cancer with pain treated at Vinh Phuc Provincial General Hospital. The pain self-management support intervention for patients with cancer through health education consultation is carried out 1 week before the patient leaves the hospital until 01 week after discharge. Intervention content includes providing information about pain, building pain management skills, and supporting patients with cancer with self-care. Patients completed the questionnaire before implementing the program and 01 week after discharge. The research period is from February 2023 to the end of July 2023. Data were analyzed using SPSS 20.0 using descriptive statistics algorithms, parametric and non-parametric tests. Results: In the intervention group, there was a statistically significant difference in the average score before intervention and after 1 week of discharge in worst pain (4.88 ± 1.55 and 3.64 ± 1.45, p < 0.05), mildest pain (2.14 ± 1.05 and 1.68 ± 0.92, p<0.05), moderate pain (3.54 ± 1.39 and 2.38 ± 1.04, p<0, 05), current pain (3.09 ± 1.76 and 2.25 ± 1.25, p<0.05), general pain (3.41 ± 1.28 and 2.49 ± 1.07, p <0.05), pain interference on daily activities (4.23 ± 1.75 and 3.48 ± 1.91, p <0.05). The study also showed that there was a statistically significant difference in the average score between the intervention group and the control group at 1 week of discharge in worst pain (3.64 ± 1.45 and 5.00). ± 1.71, p<0.05), moderate pain (2.38 ± 1.04 and 3.46 ± 1.61, p<0.05), current pain (2.25 ± 1.25 and 3.31 ± 1.88, p < 0.05), general pain (2.49 ± 1.07 and 3.50 ± 1.52, p < 0.05), pain interference on daily activities days (3.48 ± 1, 91 and 4.35 ± 2.18, p<0.05). The influence coefficient for general pain intensity is moderate (Cohens d = 0.76), and the influence coefficient for the influence of pain on daily activities is small (Cohensd = 0.42). Conclusions: The pain self-management support intervention for patients with cancer through health education consultation has been effective in reducing pain and reducing pain interference with daily activities in patients with cancer. In caring for patients with cancer, it is recommended to strengthen health education and counseling on pain management for them so that they can self-manage pain and contribute to controlling their pain.

Ashermans Syndrome, also known as intrauterine adhesions or synechiae, is a rare but clinically significant condition characterized by the formation of fibrous tissue within the uterine cavity, resulting in adhesions and obliteration of the endometrial cavity. This condition often leads to a spectrum of menstrual disturbances, infertility, and recurrent pregnancy loss. The purpose of this comprehensive review article is to elucidate the multifaceted aspects of Ashermans Syndrome, encompassing its pathophysiological mechanisms, diagnostic challenges, and various treatment modalities. A thorough understanding of this syndrome is crucial for healthcare providers to offer optimal care and management options to affected patients, ultimately improving their reproductive outcomes and quality of life.

Diabetic foot complications are a prevalent and serious consequence of diabetes mellitus, often necessitating complex clinical decisions. Among these decisions, the choice between amputation and revascularization in patients with diabetic foot poses a significant clinical dilemma. This article provides a comprehensive review of the epidemiology, significance, definition, risk factors, complications, and management options associated with amputation and revascularization in diabetic foot patients. The discussion evaluates the factors influencing the choice between these two interventions and explores their respective outcomes. Ultimately, this review underscores the importance of a multidisciplinary approach, patient-centered care, and shared decision-making in addressing this challenging clinical scenario.

Diabetic foot complications are a prevalent and serious consequence of diabetes mellitus, often necessitating complex clinical decisions. Among these decisions, the choice between amputation and revascularization in patients with diabetic foot poses a significant clinical dilemma. This article provides a comprehensive review of the epidemiology, significance, definition, risk factors, complications, and management options associated with amputation and revascularization in diabetic foot patients. The discussion evaluates the factors influencing the choice between these two interventions and explores their respective outcomes. Ultimately, this review underscores the importance of a multidisciplinary approach, patient-centered care, and shared decision-making in addressing this challenging clinical scenario.

Refractory anaphylaxis is defined as anaphylaxis which, after treatment with at least 2 doses of minimum 300 microgram epinephrine, does not achieve normalization of symptoms. Dysregulation of NO synthesis and vascular smooth cell guanylate cyclase activation may have a role in refractory vasoplegia. Methylene blue is competitive inhibitor of NO synthase and guanylate cyclase. Thus, blocking the effects on cGMP mediated smooth muscle relaxation and vasodilation and mast cell mediator release. Thus, methylene blue has been implicated as a treatment option for refractory vasoplegia. We present the case of a 21-year-old male who presented with anaphylactic shock that was unresponsive to epinephrine. After administration of methylene blue, his blood pressure and sensorium improved; and he was gradually extubated. Hence, our clinical experience suggests that methylene blue is a safe treatment option for refractory anaphylactic shock.

Advanced wound management using Negative Pressure Therapy (NPT) has emerged as a revolutionary approach in the care of complex and chronic wounds. NPT, also known as Negative Pressure Wound Therapy (NPWT), employs subatmospheric pressure to promote wound healing. This review explores the epidemiology and significance of advanced wound management, provides a theoretical framework for understanding NPT, discusses its application in different clinical scenarios, outlines potential complications, and highlights its management strategies. The evidence suggests that NPT is a valuable tool in modern wound care, but its application should be guided by a comprehensive understanding of patient needs and the wounds characteristics. Ultimately, NPT offers promising results for wound management, provided it is integrated into a holistic care approach.

Burn injuries are a significant public health concern, with a substantial global burden. These injuries can result in complex, life-threatening situations that require advanced management strategies. This review explores the epidemiology, significance, and advanced management of burn patients. We delve into the theoretical framework, covering definitions, risk factors, complications, and various management approaches. The discussion highlights the latest advances in burn care, including early burn wound excision, fluid resuscitation, infection control, and rehabilitation. The evolving landscape of burn care research and its implications for improved patient outcomes are emphasized. In conclusion, this article underscores the importance of a multidisciplinary approach to burn patient care and the need for continued research to enhance the quality of life for survivors.

Psoriatic Arthritis (PsA) is a multifaceted autoimmune disorder characterized by the intersection of psoriasis and arthritis. Recent advancements in PsA management have reshaped the landscape of treatment, providing hope for patients with previously limited therapeutic options. Emerging biologic therapies and Janus Kinase (JAK) inhibitors have revolutionized PsA care, offering targeted relief and disease progression slowdown. Personalized medicine has emerged as a key approach, tailoring treatments to individual patient profiles. Early diagnosis remains pivotal, and diagnostic criteria have enhanced accuracy. A holistic approach to care, encompassing therapies, lifestyle modifications, psychosocial support, and comorbidity management, has become integral. Continued research explores novel therapeutic targets, biomarkers for personalized treatment, and long-term safety and efficacy. These advancements underpin the evolving PsA landscape, promoting a better quality of life and improved long-term outcomes for those affected.

The vascular ring (VR) is a rare congenital anomaly that can cause compression of the trachea or esophagus, resulting in respiratory and/or gastrointestinal symptoms. The severity of symptoms depends on the type of VR, with patients who have anatomically complete VRs typically presenting earlier in life. The diagnosis of VR has advanced with the availability of improved imaging modalities. Prenatal diagnosis is possible with fetal echocardiogram, while non-invasive multidetector CT and MRA can be utilized for later diagnosis. These imaging modalities allow for the delimitation of the defect and the identification of the anatomy for treatment planning. This case report presents the evaluation and management of a male neonate who was diagnosed with VR after initially presenting with respiratory and gastrointestinal symptoms that were suspected to be related to gastroesophageal reflux. This case highlights the importance of considering VR in the differential diagnosis of patients presenting with these symptomatologies.

Introduction: Amiodarone is a benzofuran derivative with highly effective class III antidysrhythmic activity used in ventricular and supraventricular arrhythmia; however, its most side effect is pulmonary toxicity, with an incidence of 0 to 10%, and a mortality of 1 to 33%. The mechanism of the adverse reaction is still a matter of investigation. Therefore, the overall objective of this study is to determine the time in which pulmonary fibrosis develops from the use of amiodarone, which we hope to obtain with the following research question: What is the time in which pulmonary fibrosis develops from the use of amiodarone? Discussion: based on the sources reviewed, these establish that there is a risk of developing pulmonary adverse reactions from the therapeutic use of amiodarone directly related to the serum concentrations of the drug, but complete these data with broader populations. Conclusions: We were able to determine from the literature review that lung injury can be activated by low and high therapeutic doses of amiodarone.

Good health and well-being are among the UN Sustainable Development Goals. Based on this, the present study aimed to investigate a prevalent disease in Iraq, namely gallstone disease, along with the microbial infections associated with cholelithiasis and their antibiotic sensitivity patterns. The study was conducted at Teaching al-Sadr Hospital and Al-Zahrawi Surgical Hospital in Maysan, Iraq, from November 2021 to December 2022. Sixty cases of cholelithiasis in men and women between the ages of 20 and 50, who underwent cholecystectomy, were selected. The most common organism identified was Escherichia coli, found in 20 patients (33%). This was followed by Pseudomonas fluorescens in 7 patients (11.6%), Klebsiella pneumoniae in 6 patients (10%), Serratia marcescens in 6 patients (10%), Pseudomonas aeruginosa in 5 patients (8.3%), Kluyvera cryocrescens in 5 patients (8.3%), Proteus vulgaris in 5 patients (8.3%), Raoultella orithinolytica in 3 patients (5%), Klebsiella oxytoca in 2 patients (3.3%), and Enterobacter cloacae in 1 patient (1.6%). The biliary organisms showed various antibiotic sensitivity patterns. The highest sensitivity was observed with Cefotaxime (71%). The other antibiotics arranged as following; Amikacin (56%), Gentamicin (50%), Ciprofloxacin (46%), Meropenem (40%), Ceftazidime (35%), Imipenem (35%), Ertapenem (10%), Ampicillin (10%), Amoxicillin clavulanate (10%), and Cefepime (8%). In addition, female gender and advanced age were noted as contributing factors to gallstones. Cholesterol stones were found to be more common than other kinds of gallstones.

Introduction: Post-surgical management of total knee arthroplasty (TKA) includes compressive bandaging or continuous suction drainage. The arches of mobility are evaluated through some validated scales such as the Knee Society Score (KSS) questionnaire, the recovery of these is still uncertain between one management and another for not finding statistically significant differences or presenting a small sample in studies already carried out. Objective: To compare the mobility arches of patients with compressive bandage vs. continuous suction drainage undergoing TKA. Methods: Prospective, longitudinal, comparative, analytical study; patients >55 years old undergoing TKA were included. They were grouped according to compressive bandage or continuous suction drainage and the arches of mobility before and after surgery were compared. Results: 68 patients were registered, 41 (60.2 %) women and 27 (39.8 %) men with a mean age of 66.5 ± 8.3 years. Compressive bandage was applied to 34 patients and continuous suction drainage to the rest. Post-surgery the final score of the questionnaire was 82.76± 8.30 for the compressive bandage group vs. continuous suction drainage 72± 12.80 (p= <0.001), which translates better evolution in bandage group. Conclusions: The data of the present study suggest that compressive bandaging as a post TKA may result in better patient functionality according to mobility arcs being necessary other studies for validation.

Trauma to the face has the potential to be life-threatening and cause facial deformities. Head injuries are usually a more severe consequence of such incidents and must be addressed earlier. Here we present a case of a 24year old male patient with history fell from motorcycle three hours before the patient was admitted to the hospital, the patient fell with the mechanism of his face hitting the asphalt first. He was diagnosed with panfacial fracture of facial bones and mild head injury. Emergency treatment need to be done for his general condition improvement, transfusion of red blood cell, admister of elecltrolyte, oxygenation and observation of consciousness, primary suture of laceration, placing erich bar wire for maxilla mandible, placing skin traction was done in the emergency room. The patient then was scheduled for open reduction internal fixation of the facial fracture after the condition was optimal enough. Maintaining the airway and limiting bleeding are fundamental concepts in the emergency department s management of maxillofacial trauma.

Background: One of the nutritional problems in children is stunting where the index (PB/U) or (TB/U) is in the threshold (z-score) between (<-3 SD) very short TB/PB category and (-3 SD). SD)-(<-2 SD) short TB/PB category. The high prevalence is caused by many factors including mothers knowledge and childs food intake. Riskesdas (2019), The prevalence of very short and short toddlers is 30.8%. Meanwhile, in Demak Regency, the prevalence of stunting reached 26.1%, Guntur village with stunting toddlers was 15%. Objective: To determine the effect of providing nutrition education with leaflet media on increasing maternal knowledge and intake of protein, zinc, calcium in stunting children. Methods : This research is a research in the field of community nutrition. This type of research is quasi-experimental with one group pretest-posttest design. The number of samples is 18 stunting children and 18 respondents are mothers of stunted children. The data collected were mothers knowledge and food intake of stunting children by interview method and filling out questionnaires. Statistical analysis using Paired T test and Wilcoxon Signed Ranks Test. Research Results: Mothers knowledge score increased by 6.77 (from 7.56 to 14.33). The average protein intake increased by 118.04 points, zinc intake increased by 71.85 points, calcium intake increased by 122.52 points. There are differences in maternal knowledge and intake of protein, zinc, and calcium in stunted children before and after being given nutrition education using leaflet media. (p= 0.007) and (p=0.008 , p=0.028, and p=0.008). Conclusion: There is an effect of providing nutrition education with leaflet media on increasing mothers knowledge and intake of protein, zinc, calcium in stunting children.

Prostate cancer remains a significant global health concern, demanding innovative and effective treatment strategies. In this era of precision medicine, gene therapy has emerged as a groundbreaking approach for the management of prostate cancer. This article provides a comprehensive review of the state-of-the-art research on the application of genetic therapy in the treatment of prostate cancer. We delve into the molecular underpinnings of prostate cancer and the intricate web of genetic alterations that drive its progression. Furthermore, we explore the diverse arsenal of genetic tools, such as CRISPR-Cas9, viral vectors, and RNA interference, which are being harnessed to target and modify prostate cancer-related genes. The article highlights the promise of gene therapy in enhancing treatment outcomes, minimizing side effects, and circumventing therapeutic resistance. Additionally, we discuss the current challenges, ethical considerations, and regulatory aspects surrounding the clinical translation of gene therapy for prostate cancer. Ultimately, this review underscores the transformative potential of genetic therapy in revolutionizing the management of prostate cancer and improving the quality of life for affected individuals.

Breast reconstructive surgery, a pivotal aspect of breast cancer management, has witnessed considerable advancements over the years. Flaps, in particular, have become an indispensable tool in this field. This bibliographic review explores the epidemiology, significance, theoretical framework, encompassing definition, risk factors, complications, and management of flaps in breast reconstructive surgery. The discussion delves into emerging techniques and sheds light on the future of this critical aspect of surgical practice.

Primary cutaneous T-cell lymphomas are a diverse group of extranodal non-Hodgkin lymphomas characterized by the infiltration of malignant T-cells within the skin. Mycosis fungoides (MF), the most common subtype, typically presents with skin-limited manifestations. However, in a subset of cases, it can herald the onset of systemic lymphoma, representing a diagnostic challenge for clinicians. This article explores a compelling clinical case of primary cutaneous T-cell lymphoma, specifically mycosis fungoides, manifesting as an initial sign of disseminated or metastatic lymphoma. We dissect the complex diagnostic and management considerations associated with this unique clinical presentation. Through a review of the current literature and clinical insights, we delineate the clinical, histopathological, and immunophenotypic features that facilitate the diagnosis and differentiation of MF as an isolated cutaneous entity from MF with secondary extracutaneous involvement. The article highlights the critical role of multidisciplinary collaboration among dermatologists, oncologists, and pathologists in achieving timely and accurate diagnosis and guiding therapeutic decisions. It further underscores the evolving landscape of treatment options for this challenging subset of patients, ranging from skin-directed therapies to systemic agents. Additionally, this case provides a stark reminder of the importance of ongoing surveillance, as the clinical course of MF may unpredictably transition to a more aggressive form. In conclusion, this case serves as a vivid illustration of mycosis fungoides with mucosis fungoides as its initial presentation, challenging the conventional understanding of primary cutaneous T-cell lymphomas. The intricate interplay of clinical, histological, and immunophenotypic data informs the diagnosis and informs the broader clinical community about the potential metamorphosis of cutaneous lymphomas into systemic lymphomas. Understanding such cases is crucial for early intervention and improved patient outcomes.

Pelvic organ prolapse is a common condition affecting women worldwide, significantly impacting their quality of life. Surgical management plays a vital role in addressing the associated discomfort and dysfunction. This bibliographic review explores the epidemiology, significance, theoretical framework, encompassing definition, risk factors, complications, and management of pelvic organ prolapse. The discussion delves into emerging techniques and sheds light on the future of this critical aspect of surgical practice.

Generalized exfoliative erythroderma is an inflammatory skin syndrome. The incidence in dermatological patients is 13 out of every 100,000 patients. Its etiology is multifactorial, so it is a challenge to identify them, among the most common causes are psoriasis, drug hypersensitivity and phototoxicity. Most of the time, the clinician is oriented to think of a direct relationship between the dermatological presentation and the consumption of medications, since it is the most published cause founded in the medical literature and indexed journals. The clinical case that we present, refers to a case of erythroderma associated to a systemic infection. So far there are three documented cases in this regard in medical databases such as PubMed [1, 2, 3]. Our report is unique in this sense, we present the clinical case of a woman in her seventh decade of life with a history of hyperuricemia and chronic eosinophilia syndrome, hospitalized for urosepsis that debuted as desquamative erythroderma.

Infantile hypertrophic pyloric stenosis (IHPS) is considered one of the most common pediatric surgical conditions. Presentation is most common between the ages of 2 to 12 weeks with a mean and median age of 5 weeks. IHPS has been reported to be more common in males than females (5:1) and in first-born children (30-40%). Throughout history, the etiology of this condition has been studied, discovering multiple genetic and environmental factors, such as newborns with increased acid secretion, nitric oxide synthase deficiency, poor innervation of the pyloric muscle, smoking during pregnancy, neonatal use of macrolides and cesarean section; however, the exact cause remains uncertain. The classic clinical presentation begins with a recent history of severe, nonbilious projectile vomiting immediately after feeding and a strong, persistent appetite. During abdominal examination, palpation of the "pyloric olive" in the epigastrium by an experienced doctor is considered a pathognomonic sign. Laboratory tests may show low chloride, potassium, and hydrogen ion levels, leading to metabolic alkalosis due to persistent vomiting. Ultrasound is the gold standard imaging study if history and physical examination are insufficient to diagnose IHPS with a reported sensitivity and specificity of up to 98% and 100% by allowing evaluation of pyloric morphology and behavior. Pyloromyotomy is considered the definitive treatment for infantile hypertrophic pyloric stenosis, but should not be performed until the baby is adequately resuscitated. Patients typically experience positive outcomes after pyloromyotomy, with low morbidity and mortality rates. Most cases recover quickly and without complications.

An episiotomy is a surgical incision in the perineum to facilitate the babys head during delivery. Physicians or midwives may use this procedure if he/she finds out the tissue around the vaginal opening begins tearing or does not seem to be stretching enough to allow the baby to be delivered. With an increasing trend for hospital births and for physicians to get involved in the normal uncomplicated birth process, there was rise in the number of episiotomies. After the baby is delivered through the extended vaginal opening, the area is applied with local anesthetic agent and incision is repaired with sutures. Our study reviewed the development in the past twenty years regarding episiotomy wound closure methods, and discovered that continuous sutures for episiotomy or perineal repair have clinical advantages in term of faster and better wound healing, more favorable scarring, shorter post-procedural pain, more rapid resumption of sexual activity, lower incidence of urinary incontinence, compared to interrupted sutures. They were also beneficial in term of less consumption of suture materials. In determining suture materials, clinicians should strongly consider the tear severity, tissue characteristics, as well as the desired aesthetic outcome.

Infantile hypertrophic pyloric stenosis (IHPS) is considered one of the most common pediatric surgical conditions. Presentation is most common between the ages of 2 to 12 weeks with a mean and median age of 5 weeks. IHPS has been reported to be more common in males than females (5:1) and in first-born children (30-40%). Throughout history, the etiology of this condition has been studied, discovering multiple genetic and environmental factors, such as newborns with increased acid secretion, nitric oxide synthase deficiency, poor innervation of the pyloric muscle, smoking during pregnancy, neonatal use of macrolides and cesarean section; however, the exact cause remains uncertain. The classic clinical presentation begins with a recent history of severe, nonbilious projectile vomiting immediately after feeding and a strong, persistent appetite. During abdominal examination, palpation of the "pyloric olive" in the epigastrium by an experienced doctor is considered a pathognomonic sign. Laboratory tests may show low chloride, potassium, and hydrogen ion levels, leading to metabolic alkalosis due to persistent vomiting. Ultrasound is the gold standard imaging study if history and physical examination are insufficient to diagnose IHPS with a reported sensitivity and specificity of up to 98% and 100% by allowing evaluation of pyloric morphology and behavior. Pyloromyotomy is considered the definitive treatment for infantile hypertrophic pyloric stenosis, but should not be performed until the baby is adequately resuscitated. Patients typically experience positive outcomes after pyloromyotomy, with low morbidity and mortality rates. Most cases recover quickly and without complications.

Infantile hypertrophic pyloric stenosis (IHPS) is considered one of the most common pediatric surgical conditions. Presentation is most common between the ages of 2 to 12 weeks with a mean and median age of 5 weeks. IHPS has been reported to be more common in males than females (5:1) and in first-born children (30-40%). Throughout history, the etiology of this condition has been studied, discovering multiple genetic and environmental factors, such as newborns with increased acid secretion, nitric oxide synthase deficiency, poor innervation of the pyloric muscle, smoking during pregnancy, neonatal use of macrolides and cesarean section; however, the exact cause remains uncertain. The classic clinical presentation begins with a recent history of severe, nonbilious projectile vomiting immediately after feeding and a strong, persistent appetite. During abdominal examination, palpation of the "pyloric olive" in the epigastrium by an experienced doctor is considered a pathognomonic sign. Laboratory tests may show low chloride, potassium, and hydrogen ion levels, leading to metabolic alkalosis due to persistent vomiting. Ultrasound is the gold standard imaging study if history and physical examination are insufficient to diagnose IHPS with a reported sensitivity and specificity of up to 98% and 100% by allowing evaluation of pyloric morphology and behavior. Pyloromyotomy is considered the definitive treatment for infantile hypertrophic pyloric stenosis, but should not be performed until the baby is adequately resuscitated. Patients typically experience positive outcomes after pyloromyotomy, with low morbidity and mortality rates. Most cases recover quickly and without complications.

Infantile hypertrophic pyloric stenosis (IHPS) is considered one of the most common pediatric surgical conditions. Presentation is most common between the ages of 2 to 12 weeks with a mean and median age of 5 weeks. IHPS has been reported to be more common in males than females (5:1) and in first-born children (30-40%). Throughout history, the etiology of this condition has been studied, discovering multiple genetic and environmental factors, such as newborns with increased acid secretion, nitric oxide synthase deficiency, poor innervation of the pyloric muscle, smoking during pregnancy, neonatal use of macrolides and cesarean section; however, the exact cause remains uncertain. The classic clinical presentation begins with a recent history of severe, nonbilious projectile vomiting immediately after feeding and a strong, persistent appetite. During abdominal examination, palpation of the "pyloric olive" in the epigastrium by an experienced doctor is considered a pathognomonic sign. Laboratory tests may show low chloride, potassium, and hydrogen ion levels, leading to metabolic alkalosis due to persistent vomiting. Ultrasound is the gold standard imaging study if history and physical examination are insufficient to diagnose IHPS with a reported sensitivity and specificity of up to 98% and 100% by allowing evaluation of pyloric morphology and behavior. Pyloromyotomy is considered the definitive treatment for infantile hypertrophic pyloric stenosis, but should not be performed until the baby is adequately resuscitated. Patients typically experience positive outcomes after pyloromyotomy, with low morbidity and mortality rates. Most cases recover quickly and without complications.

Choledocholithiasis has an incidence of 5-10%, 21-34% are secondary to stone migration. The incidence increases with age. The most frequent complications are biliary pancreatitis, cholangitis, or liver abscesses.1 For the diagnosis, the conjunction of clinical symptoms, laboratory and imaging is required; ultrasound has a sensitivity of 77 to 87%. 2,3 The treatment is surgical, previously the two-stage approach was accepted, however, currently there has been an important change in the treatment, some surgical units perform ultrasound endoscopy with sphincterotomy preoperatively when choledocholithiasis is suspected, while others combine surgical extraction of stones with laparoscopic cholecystectomy in a single surgical event. 4,5 Another change in the current surgical treatment is the controversial use of the T-tube, since the main indication for its placement is the suspicion of a residual stone, however, this recurrence appears in a minimum percentage and the complications that derive from the placement of this are greater than its benefit, which is why a primary choledochorrhaphy is currently preferred. 5,6 Several studies that have compared these two approaches have concluded that the approach in a single surgical event is better, since hospital time is shorter, stone extraction is more successful, and postoperative complications are less frequent. 6,7

Introduction One of the most common conditions leading to impairment, particularly in the elderly, is osteoarthritis (OA). Most often caused by knee and/or hip OA, OA is the most prevalent articular disease in the developed world and a major contributor to chronic. OA is recognized as a major contributor to disability and impairment, and it has a significant socioeconomic cost due to medical and surgical procedures, as well as lost productivity. OA is a complex chronic illness that begins with joint cartilage disintegration and progresses to synovitis, subchondral sclerosis, and the development of peripheral osteophytes. A treatment option for osteoarthritis cartilage injuries is platelet-rich plasma (PRP) therapy, which is linked to a decrease in tissue inflammation. However, there is still a lack of clinical research on PRP administrations price, length of treatment, and possible application as a treatment for articular cartilage injuries. Objectives This study aimed to examine the clinical outcomes of patients with knee osteoarthritis, comparing the clinical results of The Western Ontario and McMaster Universities Arthritis Index (WOMAC) between PRP and HA intra-articular injection. Methods The medical term “PRP”, “HA”, and “Knee Osteoarthritis” were used in Pubmed and Google Scholar to discover studies of the efficacy of Intra-articular PRP injection VS HA in decreasing WOMAC scores up to October 2023. Two independent reviewers excluded the non-RCTs and other clinical studies irrelevant to the study question. Seven remaining studies were reviewed and screened for inclusion based on relevance to the subject and outcomes. Results Based on seven studies in this review, two studies showed that intra-articular platelet-rich plasma has a superior outcome on decreasing the WOMAC score than intra-articular hyaluronic acid injection with significant. Five of seven studies demonstrated that PRP has better outcomes on WOMAC score, even if not significantly. Conclusions PRP intra-articular injection is a clinically meaningful improvement for patients with knee OA, with no significant difference between treatment groups

Wound healing is a complex process critical for tissue repair post-injury. Botanicals, renowned in traditional medicine, hold potential in wound healing due to their bioactive compounds. Etlingera elatior, a Zingiberaceae family member, is attracting attention for its diverse medicinal properties. Indigenous to Southeast Asia, it has been traditionally used for wound care, attributed to its anti-inflammatory, antioxidant, and antimicrobial effects. Recent scientific investigations highlight its ability to promote tissue repair, diminish inflammation, and counteract oxidative stress. These findings position Etlingera elatior as a promising candidate for wound healing management, particularly in plastic surgery. However, its clinical translation faces challenges, including limited clinical trials and mechanistic understanding, necessitating standardized extraction methods and regulatory approval. Bridging the gap between botanical therapies and clinical use requires robust clinical trials, mechanistic studies, and formulation optimization. Collaboration among researchers, clinicians, and regulators is pivotal in realizing Etlingera elatiors wound healing potential.

Introduction: Trichoepithelioma is a rare benign tumor, predominantly found on the face and scalp, with an unclear prevalence in general population. Low incidence and lack of evidences, made trichoepithelioma management still a controversial domain in dermatology. Case: This study presented a 31-year-old woman with extensive trichoepithelioma on her nose, who underwent surgical excision and full-thickness skin grafting Result: Patient showed satisfaction with favorable aesthetic result and the consequent improvement in quality of her daily life. Discussion: Nasal intricate anatomy poses specific challenges in managing tumor like trichoepithelioma, emphasizing the importance of careful surgical planning. Surgical excision, Mohs surgery, and laser ablation are viable options, while non-surgical treatments such as topical therapies and cryotherapy are effective for superficial lesions. Patient satisfaction and quality of life are essential considerations, requiring open communication and psychological support. Emerging techniques, including advanced imaging, 3D bioprinting, and targeted molecular therapies, hold promise for optimizing trichoepithelioma management. Personalized approaches based on genetic profiling and collaborative research efforts are avenues for future exploration. Conclusion: Surgical management of trichoepithelioma on the nose, while challenging due to aesthetic concerns, can yield favorable outcomes. The approach to trichoepithelioma management should consider lesion size, surgical and non-surgical options and preference of the patient. Proper excision and meticulous skin grafting may provide aesthetically pleasant result. Personalized care, including psychological support, is crucial for post-surgery patient satisfaction. Multidisciplinary collaboration optimizes patient care in these unique cases.

Neurodegenerative diseases have a significant impact on individuals and society. The exact causes of these diseases are not fully understood, but evidence suggests that a combination of genetic, environmental, and lifestyle factors contribute to their development. Methods: This narrative review explores the role of epigenetic regulation in gene expression during the development of neurodegenerative diseases. An exhaustive literature search was conducted using electronic databases, and articles focusing on epigenetic regulation in the context of neurodegenerative diseases were selected for analysis. Epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNA molecules, play a crucial role in regulating gene activity and have significant implications for cellular function and disease development. Abnormal DNA methylation patterns have been associated with neurological disorders and neurodegenerative diseases, such as Alzheimers disease and Parkinsons disease. Histone modifications have also been implicated in the regulation of gene expression in neurodegenerative diseases. Non-coding RNAs, including microRNAs and long non-coding RNAs, are involved in gene expression regulation and have been found to be dysregulated in neurodegenerative diseases. Conclusion: Understanding the role of epigenetics in neurodegenerative diseases offers insights into disease development and progression. It provides opportunities for the development of potential therapeutic strategies that target epigenetic modifications. However, studying epigenetic changes in neurodegenerative diseases presents challenges, including the complexity of epigenetic regulation and the heterogeneity of the diseases. Nonetheless, the therapeutic potential of epigenetic regulation in neurodegenerative diseases is promising, with potential strategies including DNA methylation modifiers, histone deacetylase inhibitors, microRNA-based therapies, lncRNA modulation, and epigenetic diets. Continued research is needed to further understand the underlying mechanisms and develop safe and effective treatments for neurodegenerative diseases.

Introduction: Rectal cancer is an increasingly common and worrying disease that affects the rectum, the terminal part of the large intestine. Early detection and treatment are crucial to improving patient outcomes. Methods: We conducted a narrative review of the scientific literature to examine nerve preservation in rectal cancer surgery. Previous studies were analyzed and relevant findings related to the preservation of autonomic and pelvic nerves, as well as the prevention of sphincter dysfunction, were identified. Results: Rectal surgeries may be associated with various complications, which can have a significant impact on patients quality of life. The preservation of the autonomic and pelvic nerves plays a crucial role in reducing postoperative urinary and sexual dysfunction. Studies have shown that nerve-sparing surgical techniques improve functional outcomes and patient satisfaction. Discussion: Nerve preservation in rectal cancer surgery requires a meticulous surgical approach and a thorough understanding of the anatomical structures involved. By preserving nerve function, not only urinary and sexual function are improved, but also overall quality of life. In addition, nerve preservation plays a critical role in preventing sphincter dysfunction after pelvic exenteration surgery. Conclusions: The preservation of autonomic and pelvic nerves in rectal cancer surgery is essential to minimize complications and improve patients quality of life. Proper patient selection and compliance with oncology criteria contribute to the preservation of sphincter function without compromising survival rates. Preoperative radiation therapy may also increase the likelihood of sphincter sparing in patients with rectal cancer

Background:Chronic kidney disease is a global public health priority that continues to grow and is associated with high morbidity rates and is the third fastest growing cause of death in the world and the fifth leading cause of death. Malnutrition often occurs in end-stage renal disease patients undergoing hemodialysis (HD). Malnutrition is caused by catabolic events during the hemodialysis process. Objective: The aim of the study was to analyze energy intake, protein and nutritional status of chronic kidney failure patients on hemodialysis at Harapan and Doa Regional Hospital, Bengkulu City. Materials/Methods: Explanatory research type, with a cross sectional approach. The study population was all chronic kidney failure sufferers who underwent hemodialysis at Harapan and Doa Hospital, Bengkulu City in June-July 2023. Data were collected by interviews and anthropometric measurements, 3x24 hour recall forms and SGA forms and from patient medical records. Data processing was carried out using univariate tests. Result:This study shows that 98% of respondents energy intake before hemodialysis had insufficient energy intake (< 80%) and 2% had sufficient energy intake (80), protein intake before hemodialysis 92% protein intake is less (< 80%) during hemodialysis and after hemodialysis 85% with less protein intake (< 80%), nutritional status of chronic kidney failure patients with hemodialysis good nutritional status (SGA score A), namely (54%) lack of protein intake, poor/moderate nutritional status (SGA B score), namely (43%), poor nutritional status (SGA C score), namely (3%). Conclusion:The conclusion of this study is that energy intake, protein and nutritional status in chronic kidney failure patients on hemodialysis are still lacking. Therefore, increasing intake needs to be done by paying attention to the patients nutritional status

Supraventricular tachycardia (SVT) is a heterogeneous group of arrhythmias used to describe tachycardias involving cardiac tissue at or above the level of the bundle of His. They usually appear in subjects without structural heart disease. However, they can sometimes cause palpitations, dyspnea, sweating, angina, or vague chest discomfort, particularly in patients with underlying heart disease. We present the case of a patient with SVT reverted during pseudonalgesia with propofol. This is a 48-year-old male patient who came for presenting a sensation of intense palpitations, an electrocardiogram was taken where the presence of wide QRS tachycardia was observed. It was decided to administer procedural sedation for synchronized electrical cardioversion, however, he presented cardioversion upon administration of propofol 50 mg (Fig 1B) after 5 minutes, improving the symptoms. Studies of propofol have described its influence on the cardiac conduction system and the ability to modify the phases of the action potential by acting on the ion channels of the myocyte membrane. Therefore, it would be interesting to see case series from large centers and electrophysiology studies that show the possible antiarrhythmic role of drugs such as propofol not described in the literature.

Rokitansky-Küster-Hauser syndrome (RKH), also known as Müllerian agenesis, represents a rare congenital disorder characterized by the absence or underdevelopment of the müllerian duct structures in phenotypic females. This condition manifests as primary amenorrhea, with a typical constellation of associated anomalies encompassing the urogenital and skeletal systems. Despite its rarity, RKH poses significant physical, psychological, and reproductive challenges to affected individuals. This comprehensive article endeavors to elucidate the complex clinical spectrum, pathogenesis, diagnostic modalities, and multidisciplinary management strategies for Rokitansky-Küster-Hauser syndrome.

Peritoneal tuberculosis (TB) corresponds to between 1 and 3% of all tuberculosis localizations is greater in developed countries, The diagnosis of peritoneal TB can be a challenge for clinicians, due to nonspecific clinical and laboratory findings, they can present signs and symptoms similar to ovarian cancer, pelvic inflammatory disease as well as peritoneal carcinomatosis. Multiple cases of patients with ascites, pelvic masses, elevated CA-125 levels, peritoneal implants, mesenteric involvement, and paracentesis without malignant cells without being able to demonstrate the presence of mycobacteria preoperatively have been described, so they are operated on on suspicion of carcinoma of the advanced ovary diagnosing tuberculosis as A 19-year-old woman was referred by an internist and digestive surgeon with abdominal distension and weight loss. The CT scan of the abdomen showed thickening of the stomach wall with ascites. CA 125 levels raised to 2100 U/mL and the At first it was addressed as ovarian cancer, laparoscopy was performed with a biopsy sample, concluding peritoneal tuberculosis. antituberculous therapy is started, 2 weeks later patient course with (DILI), with torpid evolution which leads to his death. The objective of the clinical case is to broaden our medical outlook with differential diagnoses in the face of chronic abdominal pain in women and to remember the importance of early diagnosis, as well as clinical follow-up, for early intervention of adverse effects.

Nigeria faces significant challenges in providing access to healthcare services for its population. An important aspect of Nigerian health policy that requires timely evaluation, is accessibility to Primary Health Care (PHC) facilities (and, indeed, other healthcare facilities) especially in rural areas. Thus, the need to investigate their distribution and spatial influence. This study employed the technology of Remote Sensing and GIS in generating relevant scientific data on the spatial distribution of healthcare facility in Plateau State. Coordinates of various health facilities were recorded using handheld GPS while various attribute information were also obtained and recorded. The results thus acquired were tabulated and segmented by local government. The type of facility (primary, secondary and tertiary) and, ownership (government or private) was tabulated and prepared for further analysis. There are 1237 health facilities spread across the state. Government PHC facilities; 615, private PHC facilities; 542, government secondary and private secondary healthcare facilities; 31 and 44 respectively and 5 tertiary healthcare facilities were documented and their spatial distribution and relationship represented graphically. Buffer distances of 0.5, 1 and 2 Kilometers and 1, 2, 3, 5 and 10 Kilometers were used for buffer analysis of the spatial relationship between facilities and settlements. This showed a reasonable coverage especially around the location of settlements within the state. Urban centers present clustering of facilities due to density of population in these areas. The cluster analysis reveals similar Nearest Neighbor Ratios for all the types of facilities with private secondary healthcare having the least with 0.606858. This is a direct consequence of the clustering of private secondary facilities around the Jos-Bukuru metropolis in the northern end of the state. Other types of facility are not too far from this ratio with government primary presenting 0.701219, private primary 0.837056 and 0.661641 for government secondary facilities. The northern senatorial district shows much of this clustering with the peak in and around the Jos-Bukuru metropolis. This can be attributed to the important role of Jos as the administrative center of the state and a major urban area. The z-scores for both government (-14.174948) and private primary healthcare facilities (-15.069804) indicates significant clustering. The z-score for government secondary (-1.735602) in correlation with its relatively high Nearest Neighbour Ratio points towards the near-equitable distribution of these facilities.

Meigs Syndrome is a rare clinical entity characterized by the triad of benign ovarian tumor, ascites, and pleural effusion. This syndrome, often masquerading as malignant disease, presents a diagnostic challenge for healthcare professionals. In this comprehensive review, we aim to provide a detailed analysis of the clinical manifestations, diagnostic modalities, and management strategies of Meigs Syndrome. We explore the epidemiology of the syndrome, emphasizing its rarity, and discuss the various etiological theories that underlie its pathophysiology. Differential diagnoses, including malignant conditions that mimic Meigs Syndrome, are examined to guide accurate and timely diagnosis. An in-depth analysis of imaging techniques, such as ultrasound, computed tomography, and magnetic resonance imaging, is included, along with the significance of tumor markers and cytology in diagnosis. The cornerstone of treatment primarily involves surgical intervention, and we delve into the various surgical approaches and outcomes. Additionally, we shed light on the postoperative course and long-term prognosis of patients with Meigs Syndrome. This review aims to equip clinicians, radiologists, and surgeons with a comprehensive understanding of this uncommon condition to facilitate prompt recognition and effective management.

Swyer Syndrome, also known as 46, XY Complete Gonadal Dysgenesis, is a rare and intriguing disorder of sexual development characterized by a phenotypic female appearance in individuals possessing a 46,XY karyotype. This enigmatic condition results from a cascade of genetic and hormonal events, which ultimately lead to the absence of functional gonads, presenting a challenging diagnostic and therapeutic conundrum. In this comprehensive review, we delve into the intricate landscape of Swyer syndrome, elucidating its genetic underpinnings, clinical manifestations, diagnostic approaches, and contemporary management strategies. By consolidating current knowledge, this article aims to provide a valuable resource for healthcare professionals, geneticists, and researchers interested in unraveling the complexities of disorders of sex development and the genetic determinants of sexual differentiation.

The management of exposed infected mesh represents a significant challenge in modern surgical practice. In this bibliographic review, we explore the epidemiology and clinical transcendence of this issue. The theoretical framework section delves into the definition, risk factors, complications, and management strategies for exposed infected mesh. The discussion highlights emerging approaches and considerations, while the conclusion underscores the importance of evidence-based practices in addressing this complex problem.

Objectives: Prediabetes is characterized by the presence of inflammation. Hematological parameters provide the advantageous qualities of being cost-effective and readily reproducible, rendering them highly helpful for the purpose of disease surveillance. The impact of vitamin D on inflammatory mediators and its role in the progression from prediabetes to type 2 diabetes has been seen. This study aims to investigate hematological markers, glycemic management, and vitamin D status among individuals with prediabetes. Methods: A retrospective investigation was performed on a cohort of 270 persons with prediabetes (5.7-6.4% glycated hemoglobin levels) and 299 participants with normal blood glucose levels. In order to conduct a comparison of hematological indicators between two groups, statistical analyses including chi square analysis and the t test were employed. The analysis of variance (ANOVA) statistical method was employed to analyze the components within three distinct categories of Vitamin D levels: acceptable (more than 75 nmol/L), inadequate (ranging from 50 to 74.9 nmol/L), and deficient (50 nmol/L). The odds ratio for prediabetes was obtained through the utilization of regression analysis. Results: The study observed a statistically significant decrease in vitamin D levels among individuals with prediabetes (mean 57.91 ± 20.83, p = 0.05). The group of individuals with prediabetes exhibited significantly higher values for the neutrophil lymphocyte ratio (2.10 ± 0.85; p = 0.05), platelet lymphocyte ratio (137.70 ± 43.70; p = 0.05), mean platelet volume (8.55 ± 3.00; p = 0.001), and red cell distribution width (12.65 ± 1.31; p = 0.05). The present study observed a statistically significant positive correlation between declining levels of vitamin D and increasing trends in the neutrophil lymphocyte ratio, platelet lymphocyte ratio, and red cell distribution width in individuals with prediabetes. The study revealed that the mean platelet volume had a noteworthy association with the development of prediabetes. Conclusions: The neutrophil lymphocyte ratio, platelet lymphocyte ratio, red cell distribution width, and mean platelet volume are emerging inflammatory markers that can be employed for monitoring purposes in patients with prediabetes. However, it is important to note that these indicators should be utilized in combination with an assessment of Vitamin D status.

L1Hs is a major player in genome evolution and genetic variability. Aberrant activity of L1Hs element is common in several human cancers. Its specific function is poorly characterized epigenetic regulation via human silencing Hub (HUSH) complex is critical to inhibit L1Hs activity. MPP8 is a subunit of HUSH complex and recently it has been suggested to inhibit L1Hs elements transcription. Thus, this assay was aimed to assess the expression level of L1Hs and MPP8 genes in cancer whole blood samples and healthy group utilizing qPCR assay. Generally, L1Hs gene significantly up regulated two times in patients blood samples compared with healthy group. MPP8 gene up regulated approximately two times in cancer samples compared with healthy group. Testes, prostate, colon and cervical cancers were significantly expressed L1Hs more than MPP8 expression. While there is no significant differ in expression level of MPP8 and L1Hs genes in breast, bladder and ovary cancers.

Cholera outbreaks occur recurrently in Baidoa, taking away the lives of so many people most of whom are children and the elderly. An earlier study on the subject discussed several aspects of the disease and its fatal consequences to the people, creating a debate over whether cholera mostly affected the large communities in the IDPs in Baidoa district and its environs or whether the host community constituted the largest number of the victims of the epidemic. To come to the bottom of the problem, this study was carried out to understand some of the possible reasons leading to outbreak of the epidemic as well as collect evidence from relevant medical personnel involved in the operation during the outbreak. The study utilizes the qualitative method to demonstrate some the reasons behind the 2017 cholera outbreak and the most affected among the people in Baidoa consisting of the host community and the IDPs. It used unstructured, open-ended interviews with health personnel consisting of medical doctors and nurses who had participated in the containment of the cholera outbreak in 2017. The results revealed that the epidemic struck the IDP communities harder than the host community in Baidoa due to factors identified as: overcrowding in IDP Camps, poor sanitation, lack of clean drinking water, lack of (or improper) latrines, faesces/ rubbish/garbage in the IDPs camps, and unpreparedness on the side of the authorities, among other causes

Cardiovascular diseases, specifically structural cardiopathies, continue to pose a significant burden on global healthcare systems. The accurate assessment of these conditions in adults demands precise and reliable imaging modalities. This article presents a comprehensive exploration of the role of two prominent diagnostic tools, echocardiography and magnetic resonance imaging (MRI), in the evaluation of structural cardiopathies in the adult population. We scrutinize the clinical utility, advantages, limitations, and diagnostic accuracy of both imaging techniques, shedding light on their respective roles in the clinical decision-making process. Furthermore, we delve into recent advancements and emerging trends in echocardiography and MRI, highlighting the potential synergistic use of these modalities to optimize the diagnostic and therapeutic approach to structural cardiopathies in adults. The findings from this review will contribute to enhancing clinical practice and patient outcomes in the management of these intricate cardiovascular conditions.

Chronic kidney disease (CKD) represents a complex and multifaceted clinical condition characterized by its intricate interaction with multiple organ systems. Among the systemic manifestations of CKD, the impact on the cardiovascular system is particularly profound. This article delves into the intricate relationship between CKD and cardiac strain, exploring the paradoxical nature of myocardial function in the context of renal dysfunction. We navigate the epidemiological landscape, describe pathophysiological mechanisms, investigate diagnostic modalities, and explore current and emerging therapeutic strategies aimed at controlling cardiac strain in CKD. This comprehensive analysis not only sheds light on the cardiac complexities within the CKD setting, but also underscores the need for a holistic approach to improve patient outcomes.

Wilkie syndrome also known as superior mesenteric artery syndrome is an unusual and rarely cause of upper intestinal obstruction and weight loss; It is characterized by duodenal compression in its third portion caused by a narrowing of the space and angle that separates the aorta from the superior mesenteric artery. This narrowing is usually secondary to multiple etiologies, the most accepted being the decrease in mesenteric fat between these arteries. The clinical picture and laboratory studies are usually not very specific, so the diagnosis is based on imaging methods, with computed tomography as the gold standard because it shows a decrease in the aortomesenteric angle and distance. Treatment is generally curative and can be conservative or surgical; this depends on the etiology, the time of evolution and symptoms of the case in question, so it should always be individualized based on patient characteristics.

Pancreatic cancer, although rare, ranks seventh in terms of cancer-related mortality, with a low five-year survival rate after diagnosis. Globally, it accounts for approximately 1.6-1.2% of cancer cases. In Mexico, it is also a significant cause of mortality, ranking sixth or seventh. This type of cancer tends to occur more frequently in individuals over the age of 71, but there has been a marked increase in its incidence among younger patients. One of the most common risk factors is a family history of the disease, and a close relationship has often been noted between pancreatic cancer and newly diagnosed diabetes mellitus. The primary objective of this study is to understand pancreatic cancer prevention in patients carrying the pathogenic mutation of the BRCA1 gene and explore innovative therapies. Both the BRCA1 and BRCA2 genes have been associated with various cancer types, such as breast, ovarian, and pancreatic cancer. In the case of the latter, it is believed that these genes may contribute to cancer by causing DNA damage. The diagnosis of pancreatic cancer is based on imaging studies and biopsies. Furthermore, various treatment options are examined, including neoadjuvant therapies and potential therapeutic approaches.

Varicella, commonly known as chickenpox, is a contagious infectious disease caused by the varicella zoster virus (VZV). Although often considered a benign childhood illness, chickenpox can lead to severe complications, particularly in susceptible populations. This article provides a comprehensive review of chickenpox, delving into its etiology, pathogenesis, clinical manifestations, and the evolving landscape of prevention and treatment. Additionally, we explore the implications of chickenpox in the context of public health and emerging trends in vaccination strategies.

Background: Autism is a condition of developmental abnormalities that have an impact on various aspects of life, including dental and oral health. An electric toothbrush is needed as a means of plaque control. Electric toothbrushes offer advantages such as timer features, increase accessibility, etc. Purpose: This study aims to determine the effectiveness of electric toothbrushes as a means of plaque control in children with autism. Methods: This study used the One Group Pretest Posttest research design and consisted of 24 subjects. This study used the Loe and Silness plaque index measurement. Before the research, education was carried out on the research subjects. The study was conducted by comparing the effectiveness of manual and electric toothbrushes on research subjects. Index scores were recorded before and after treatment. Results: The use of manual and electric toothbrushes both reduced the Loe and Silness plaque index scores. The use of a manual toothbrush reduced the mean plaque index score by 0.828 (34.07%). The use of an electric toothbrush reduced the average plaque index score by 1.10 (48.24%). The results of the paired t test (P <0.05) showed that there was a significant difference between the use of a manual toothbrush and an electric toothbrush. Conclusion: The use of an electric toothbrush can reduce plaque scores and is effective as a means of plaque control in school-age autistic children.

Background: The nutritional requirements of pregnant women significantly rise compared to their non-pregnant state, and failing to meet these heightened needs can lead to the development of Chronic Energy Deficiency (CED). This study was designed to investigate macronutrient intake and the prevalence of Chronic Energy Deficiency (CED) in pregnant women residing in the Stunting Village area of Argamakmur Sub-District, North Bengkulu Regency, Bengkulu Province. Materials/Methods: This study was of a quantitative nature, employing a cross-sectional design. The population comprised all 165 pregnant women in Argamakmur Sub-District, North Bengkulu Regency, with a sample of 60 pregnant women selected through cluster sampling techniques. Data collection involved the use of a 3 x 24-hour food recall questionnaire. The analysis of the data was performed using univariate, bivariate, and multivariate methods. Result: The findings of this study indicated that over 50% of pregnant women had insufficient carbohydrate intake (56.7%), and 50% had inadequate protein intake, while 58.3% had deficient fat intake. There was a significant relationship between carbohydrate intake and the occurrence of Chronic Energy Deficiency (CED) in pregnant women, as well as between protein intake and CED in pregnant women. Similarly, there was a significant relationship between fat intake and the incidence of CED in pregnant women in Argamakmur Sub-District, North Bengkulu Regency, with a p-value less than 0.05. Conclusion: Carbohydrate intake, protein intake, and fat intake are all associated with the occurrence of Chronic Energy Deficiency (CED) in pregnant women. This underscores the importance of enhancing health services to provide nutritional education concerning maternal dietary intake during pregnancy. Such efforts aim to ensure that pregnant women consistently consume food that aligns with their nutritional requirements

Los tumores del estroma gastrointestinal son conocidos como las neoplasias mesenquimales más comunes, sin embargo, solo representan menos del 3% de las neoplasias gastrointestinales malignas. Sus síntomas, evaluación bioquímica y diagnóstico por imágenes son variables e inespecíficos y dependen de la ubicación y tamaño del tumor al momento del diagnóstico, los análisis histopatológicos e inmunohistoquímicos son necesarios para un diagnóstico certero en un 95% en la mayoría de los casos. Estos tumores expresan actividad tirosina quinasa, por lo que si no es posible la resección completa del tumor o en aquellos tumores con alto riesgo de recurrencia, puede estar indicado el manejo con inhibidores de la tirosina quinasa (imatinib), lo que ha mejorado significativamente el pronóstico de la enfermedad.

Due to its short range in tissue and high dose gradient beta radiation may be used to the therapy of small and superficial skin lesions. In this short study a conceptual design of a novel multi-hexagonal beta applicator loaded with Yttrium-90 is presented. Calculations of dose rates around the applicator area performed using the beta-point source dose function formalism and initial results show that over 90\% of the beta radiation energy from the multi-hexagonal applicator loaded with Yttrium-90 is absorbed in the first layers of the skin tissue. Results show that the multi-hexagonal beta applicator has the potential to be used in the brachytherapy treatment of non-melanoma skin cancers.

Background: Recent studies have suggested an increased rate of adverse events in women following left atrial appendage occlusion (LAAO), particularly with dual occlusive mechanism devices. Objectives: This study aimed to investigate gender disparities in in-hospital adverse events and short-term device-related outcomes in an experienced center using dual occlusive mechanism devices exclusively. Methods: In a single-center retrospective study, patients who received dual occlusive mechanism devices (Amplatzer cardiac plug and Amulet) were analyzed. We assessed gender differences in patient characteristics, LAAO indications, procedural data, in-hospital complications, and short-term device-related outcomes in the form of one-month follow-up transesophageal echocardiography. Results: Among 474 patients, 211 (45%) were women. At device implantation, women were significantly older (77.45±6.98 years vs. 75.89±7.26; p = 0.01), with higher CHA2DS2Vasc scores (5.03±1.46 vs. 4.28±1.51; p < 0.01) and lower HASBLED scores (3.78±1.06 vs. 4.03±1.12; p = 0.01) compared to men. Men had a higher prevalence of coronary artery disease (52% vs. 32%; p < 0.01). LAAO indications did not significantly differ. Device success was 99% in men and 98% in women (p = 0.75). In-hospital complications, including deaths, major bleedings, and pericardial effusion, did not significantly vary by gender. Rates of device-related thrombus and device closure with a residual jet = 5 mm were similar. Conclusions: In a large cohort of consecutive LAAO patients at an experienced center, gender was not linked to higher in-hospital complications.

Glioblastoma, the most aggressive and lethal primary brain tumor, presents a formidable challenge to clinicians and researchers alike. This article provides a comprehensive overview of the latest developments in the management of glioblastoma, focusing on therapeutic strategies and emerging directions for improved patient outcomes. The aggressive nature of glioblastoma calls for a multifaceted approach, and this review examines the current state of surgical, radiotherapeutic, and chemotherapeutic interventions. Furthermore, we explore the promising avenues of targeted therapies, immunotherapy, and the role of precision medicine in tailoring treatment for individual patients. Additionally, we discuss the challenges of overcoming treatment resistance, the potential of combining modalities, and the impact of genetic and molecular profiling. This article serves as a critical resource for clinicians, researchers, and policymakers involved in the ongoing battle against glioblastoma, shedding light on the evolving landscape of glioblastoma management.

Posterior Reversible Encephalopathy Syndrome (PRES) is a diagnosis based on neuroimaging with the finding of vasogenic edema, especially in the occipital and parietal lobes. Some of the risk factors include malignant hypertension, chronic kidney failure, organ transplantation, autoimmune, immunosuppressant drugs, chemotherapy, and sepsis. The PRES mechanism is due to disrupted autoregulation, especially in the posterior circulation which is associated with hypertension and hypoperfusion. This will cause damage to the blood-brain barrier and vasogenic edema. We report a woman, 70 years old, with the chief complaint of loss of consciousness accompanied by headache, vomiting, and restlessness. The patient has chronic hypertension and routine hemodialysis due to chronic kidney failure. On physical examination, the patient was somnolent, malignant hypertension, and hemiparesis sinistra. Imaging examination showed vasogenic edema of the right parietooccipital lobe. The patient was treated in the intensive care unit, given intravenous dexamethasone, antihypertension, antibiotic, and routine hemodialysis. Consciousness gradually improved.

Ependymomas are primary central nervous system (CNS) neoplasms arising from ependymal cells lining the ventricular system and spinal cord. They represent a heterogeneous group of tumors with distinct histological and molecular subtypes, making their diagnosis, management, and prognosis a complex and evolving challenge in the field of neuro-oncology. This comprehensive review delves into the intricate landscape of ependymomas, elucidating their pathogenesis, classification, and molecular underpinnings. Histologically, they can manifest as myxopapillary, subependymoma, and anaplastic ependymomas, each carrying distinct clinical implications and therapeutic strategies. Moreover, recent advancements in molecular profiling have unveiled significant genetic alterations such as amplifications in RELA, YAP1, and C11orf95-MAML2 fusion, which have profound implications for prognosis and therapeutic decision-making. We explore the intricacies of clinical management, encompassing surgical resection, radiation therapy, and chemotherapy regimens tailored to the tumors location, grade, and molecular profile. Despite their location within the CNS, ependymomas are notorious for their diverse clinical presentations, including headache, neurological deficits, and intracranial hypertension, necessitating multidisciplinary care and vigilant surveillance. Additionally, this article investigates the latest developments in targeted therapies, immunotherapeutic approaches, and ongoing clinical trials in an attempt to provide a glimpse into the future of ependymoma treatment, as precision medicine begins to play a more significant role in guiding therapeutic decisions. Furthermore, the abstract examines the critical issue of ependymoma prognosis, emphasizing the importance of integrating histopathological and molecular data in order to stratify patients into risk categories more accurately. The role of genetic markers, such as chromosome 1q gain and chromosome 6q loss, in predicting outcomes is thoroughly explored. In summary, this article aims to offer a comprehensive perspective on ependymomas, from their cellular origins to the latest breakthroughs in their management, offering insights into their clinical course, and underscoring the critical role of multidisciplinary collaboration in advancing the understanding and treatment of these complex intracranial tumors.

prevalent worldwide. Individuals may experience adverse consequences as a result of their limited understanding of symptoms and risk factors. The purpose of this article is to assess the level of awareness and understanding among the general people in the Kingdom of Saudi Arabia (KSA) regarding thyroid problems. Methodology: A cross-sectional online survey was done among the general public of Saudi Arabia using a pre-designed online questionnaire. The survey consisted of many sections that included questions requiring responses of yes, no, or I dont know. The statistical software package utilized for all statistical studies was SPSS version 21. The findings of the study encompassed a total of 2362 individuals, with 53% representing the female population and 47% representing the male population. A total of 40.7% of the individuals included in the study fell between the age range of 21 to 30 years. The majority of participants (97.7%) reported prior knowledge of the thyroid gland. In the study, it was found that 30.9% of the participants had a high level of knowledge regarding thyroid glands, while 50.8% exhibited a moderate level of knowledge, and 18.9% shown a poor level of knowledge. A noteworthy correlation was observed between comprehension of thyroid disease and both gender and age. Conclusion: The level of understanding among the general people in Saudi Arabia regarding thyroid problems was found to be quite low in comparison to global statistics. It is recommended that health authorities organize health education events of greater efficacy in order to enhance the understanding of thyroid disorders among the general population and caregivers. These events should emphasize the need of early detection and proper management of such conditions.

Honey, a natural product with a rich history in wound care, has gained renewed attention as a topical treatment for wounds in modern medicine. This bibliographic review explores the epidemiology, significance, theoretical framework, encompassing definition, risk factors, complications, and management of honey in wound care. The discussion delves into emerging applications and future directions in the use of honey as a therapeutic agent for wound healing.