Adenomas are benign, premalignant neoplasm composed of dysplastic epithelium. In lower Gastro intestinal tract, adenomatous polyps most commonly occur in colon and rectum. Although rare, it can also arise in anal canal. These neoplasms have the potential to transform into malignancy. Primary Adenocarcinoma arising from prolapsed hemorrhoids being an extremely rare entity warrants an interdisciplinary approach to treatment.

Aim: To evaluate and compare the fracture resistance of endodontically treated teeth irrigated with different irrigating solutions under instron testing machine.

Referring to the United Nations Programme on HIV and AIDS (UNAIDS), a total of 37.9 million people suffer from HIV/AIDS. Meanwhile, HIV/AIDS cases in Indonesia entered the 3rd column in the world and occupied the first level in the Asia Pacific continent. The number of HIV/AIDS cases in Indonesia reaches 46 thousand cases and around 640 thousand people are living with HIV positive (UNAIDS, 2019).

Background: Coronary heart disease Acute Coronary Syndrome (ACS) accounts for about 7 million deaths every year. Patients with ACS require cardiac rehabilitation which aims to restore optimal physical, medical, psychological, social, emotional, sexual, and vocational conditions. Early mobilization is needed to optimize health status in ACS patients. For patients whose hemodynamic status is not balanced, a solution that can be suggested is to train the patient to tolerate changes in position rather than leaving him in the supine position.

Endoscopic ultrasound gives high resolution images of the mediastinum and abdominal organ and improves visualization for obtaining tissue sample for cytology. In our study 112 subjects underwent EUS guided FNAC, out of them 51 were diagnosed as carcinoma (45.5%), 15 as tuberculosis (13.39%), reactive adenitis is 13 (11.6%), other benign disease is 27 (24.1%). So overall diagnosis we made in (106/112) (94.6%). 6 (5.3%) were inconclusive. We suggest that EUSFNAC should be the first line investigation for suspected mediastinal and intra-abdominal malignant masses.

Endoscopic ultrasound gives high resolution images of the mediastinum and abdominal organ and improves visualization for obtaining tissue sample for cytology. In our study 112 subjects underwent EUS guided FNAC, out of them 51 were diagnosed as carcinoma (45.5%), 15 as tuberculosis (13.39%), reactive adenitis is 13 (11.6%), other benign disease is 27 (24.1%). So overall diagnosis we made in (106/112) (94.6%). 6 (5.3%) were inconclusive. We suggest that EUSFNAC should be the first line investigation for suspected mediastinal and intra-abdominal malignant masses.

Introduction: Malnutrition including obesity has long been an urgent health issue worldwide, but COVID-19 has put more challenges to its management. Aided with technology, personalized nutrition is a novel potential solution. Therefore, this paper aims to evaluate the efficacy of technology-assisted personalized nutrition therapy in managing nutrition problems. Methods: We conducted literature screening through databases including PubMed, Scopus, Cochrane, ScienceDirect, EBSCOHost, and Google Scholar, searching for clinical trials implementing technology-assisted personalized nutrition therapy up to August 2021. Quality of studies were evaluated using the Cochrane Risk of Bias 2.0 tool and converted to AHRQ standards. We conducted qualitative extraction and quantitative analysis of mean differences using Review Manager 5.4 in inverse variance, random-effects model and whenever possible, subgroup and sensitivity analyses were performed. Results: Our search yielded 9 studies with 5,173 participants. Technology-assisted personalized nutrition, delivered through web, mobile, or telephone-based approaches, is proven effective in improving anthropometric outcomes including weight (pooled MD: -0.82; 95%CI:-1.30—0.35; p=0.0007) and BMI of (pooled MD: -1.30; 95%CI:-1.97—0.62; p<0.00001) of the target participants. Improvements in dietary pattern is also significant as seen in better intakes of fruits and vegetables (pooled MD: 0.86; 95%CI:0.18-1.53; p=0.01), reduction of saturated fat and sweetened beverages, as well as general diet scores. Additionally, markers of inflammation, oxidative stress, total cholesterol, and blood glucose of participants also decreased significantly with the intervention. Conclusion: Technology-assisted personalized nutrition is proven to be more effective compared to previous population-based intervention, thus supporting its potential use in clinical settings.

Endoscopic ultrasound gives high resolution images of the mediastinum and abdominal organ and improves visualization for obtaining tissue sample for cytology. In our study 112 subjects underwent EUS guided FNAC, out of them 51 were diagnosed as carcinoma (45.5%), 15 as tuberculosis (13.39%), reactive adenitis is 13 (11.6%), other benign disease is 27 (24.1%). So overall diagnosis we made in (106/112) (94.6%). 6 (5.3%) were inconclusive. We suggest that EUSFNAC should be the first line investigation for suspected mediastinal and intra-abdominal malignant masses.

Inrtoduction: Cardiac tumors are exceedingly rare. Majority of tumors are metastatic secondaries rather than that of primary cardiac origin. Even if most of the tumors are benign, the cardiac location itself can be fatal. Advanced imaging modalities have enabled early detection of cardiac tumors. In the present study we analysed a series of 7 primary cardiac tumors over a period of 3 years, with reference to clinical, radiological, morphological and immunohistochemical findings at the Department of Pathology, Government medical college, Thiruvananthapuram. Method: Institutional records were reviewed for all the diagnosed primary cardiac tumors. Results: We reviewed 7 cases of primary cardiac tumors .All cases were adults with equal gender distribution. The majority of cases were benign primary cardiac myxomas, exclusively in left atrium. One case each of epithelioid hemangiendothelioma involving both right and left atria and cardiac angiosarcoma involving the interatrial septum were diagnosed. Conclusion: Although cardiac tumors are rare entity, its prompt diagnosis has significant role in reducing patient mortality and morbidity.

Mesenchymal hamartoma of liver is the third most common hepatic tumor in pediatric age group. Typically, it presents as a large multicystic mass in children. Gradually they get increases in size and some can undergo incomplete spontaneous regression and very rarely, few have shown malignant transformation to undifferentiated(embryonal) sarcoma. Here, we report a 6 year old female child with no relevant personal and family history, who presented with abdominal distension and vomiting. Radiology revealed a multiloculated large cystic lesion in the right lobe of liver with a possibility of hemangioendothelioma on ultrasonography and CT abdomen was suggestive of mesenchymal hamartoma of liver. Following worsening of symptoms, partial excision and marsupialisation of the cyst was performed. Histologically, it was diagnosed as mesenchynal hamartoma with undifferentiated embryonal sarcomatous component and immunohistochemical confirmation done.

Hemophagocytic lymphohistiocytosis is a rare hematologic disorder caused by dysregulated immune activation and carries a high rate of mortality. It is categorized broadly into Primary (Familial ) and secondary types. The recent classification of histiocytoses by Histiocytic society has placed Hemophagocytic lymphohistiocytosis in the “H” group. Greater awareness of Familial hemophagocytic lymphohistiocytosis is required among clinicians and pathologists for early diagnosis and a better survival. Here we report a case of Familial hemophagocytic lymphohistiocytosis correlating with clinical history, family history, bone marrow findings and genetic tests.

Objectives: This retrospective study investigates the prevalence and angulation of impacted mandibular third molars and the most affected sex in a sample of Libyan patients between the ages of (19 and 84) who live in Zliten, Libya. Study Design: Sixty-nine patients between the ages of (19 and 84) referred to the Assalam Dental Centre were included in this retrospective study. Of the 69 patients, 30 females and 39 males were assessed for the prevalence and position of an impacted mandibular third molar on panoramic radiographs. Results:Out of 124 mandibular third molars, seventy-six were found to be impacted on both right and left sides, from which mesioangular impaction was the most common angulation in females. In contrast, vertical impaction was the most common in males. In addition, the prevalence of impacted mandibular third molars were more in females. Conclusion: The prevalence of impacted mandibular third molars is higher in females than males, and mesioangular impaction is the most common in females, while vertical angulation is frequently common in males.

Introduction: Chronic hepatitis C virus (HCV) infection is one of the major cause of cirrhosis of liver and leads to significant morbidity and mortality. In past, HCV therapy was limited to subcutaneous peg interferon plus oral ribavirin, a regimen that was generally poorly tolerated and provided low efficacy, with cure rates below 40% for HCV genotypes 1 and 4, and below 75% for HCV genotypes 2 or 3. The availability of oral direct-acting antiviral (DAA) as treatment for chronic hepatitis C has revolutionized the field. Although current HCV therapies rarely fail to achieve viral eradication, a subset of patients experience treatment failure. Aim: To study the risk factors associated with treatment failure with oral antiviral drugs in patients of Chronic hepatitis C. Materials & Methods: It was a retrorospective study done at Medical Gastroenterology Department, PGIMS, Rohtak in which six years data i.e.from 01.01.2015 to 31.12.2020, pertainining to Eighty Six (86) chronic hepatitis C patients who had treatment failure i.e. SVR failure on oral antiviral drugs was analyzed. Observations: Out of the total 86 patients, there was clear cut male predominance i.e. 54 (62.79 %) with rural background (villages) i.e.73 (84.88%). The age distribution in these 86 patients varied between 10-80 yrs of age and characterstically peak was seen in 31-40 yrs age group i.e.25 patients (29.06 %). The majority of patients had high baseline HCV viral load (> 4 lakhs I.U. /ml) i.e. 52 patients (60.46%). Out of total 86 patients, , 50 patients (58.13%) were cirrhotic, 34 patients (39.53 %) were smokers, 33 patients (38.37%) were alcoholic, 26 patients (30.23 %) had past history of surgical intervention, 9 patients (10.46 %) were diabetic, 9 patients (10.46 %) had got tattoo, 8 patients (9.30%) had history of previous blood transfusion and 13 patients (15.11%) gave history of use of alternative medications. Results: The direct risk factors associated with development of failed SVR in HCV patients are high baseline HCV RNA viral load, cirrhosis, rural background and indirect risk factors are smoking, alcohol and Diabetes Mellitus but large scale studies in future are required to confirm the same.

Serum lactate dehydrogenase (LHD) concentration has been described as a biomarker to predict severe lung injury and severe hypoxemia in patients with ARDS. The aim of the study was to correlate lactate dehydrogenase concentrations with the tomographic severity index in SARS-CoV-2 pneumonia cases, considering lung CT as the gold standard for severity diagnosis in this population based on the presence of ground glass pattern and the score given in the segmental assessment. A total of 110 patients were included in the study, in the period from April to September 2020. From the results, a moderate correlation was obtained between serum LHD levels and severity score by pulmonary tomography, with an r=0.474 and p <0.0001; with a severity-associated serum LHD cut-off point of 396 mg /dl (p < 0.001, sensitivity 86.02%, specificity 75%, AUC 0.806). Serum DHL levels may be useful for predicting severity in patients with COVID pneumonia 19t.

Background: Placenta praevia is a major cause of antepartum haemorrhage. It is associated with high foeto-maternal morbidity and mortality. The study was aimed at reviewing cases of placenta praevia managed at the Rivers State University Teaching Hospital (RSUTH) over 6 years, to determine the prevalence, trend, and sociodemographic/obstetrics factors. Methods: A descriptive cross-sectional study of all recorded cases of placenta praevia managed at RSUTH from 1st January 2016 to 31st December 2021. Descriptive and inferential statistics were derived using IBM, Statistical Product and Service Solution (SPSS) version 25.0 Armonk, NY. Results: There were 14,195 deliveries and 137 cases of placenta praevia; giving the prevalence of 0.97% or 9.7 per 1000 or 1 in 103 deliveries The rate of placenta praevia per 1000 deliveries increased from 0.98 in 2016 to 3.03 in 2018 and then decreased to 1.54 in 2021. The mean (SD) age and gestational age of the participants were 32.5±4.9 (95% CI: 31.67, 33.34) years and 36.7 ±2.6 (95% CI: 36.34,37.10) weeks. The modal parity was para 1. The median blood loss was 600mls range 300-3,200 mls. The majority of the patients were booked 116 (84.7%), multiparas 65(47.4%) and had tertiary level education 56(40.9%). The most common risk factor identified was the history of a previous caesarean section 66(37.5%). Conclusion: The prevalence of placenta previa in RSUTH is 0.97%; with a declining pattern of occurrence. Placenta praevia occurs more among multiparous women with a history of previous caesarean sections. Knowledge of this will be helpful to clinicians in making diagnosis and management of cases.

Introduction: This study was done to assess the knowledge and health behaviour regarding osteoporosis in khandagiribari. And to find out the association between knowledge and health behaviour with selected socio- demographic variables. Methods and material: quantitative experimental approach and non randomized control group design was adopted. 200 people were selected by purposive sampling technique, who were met the inclusion criteria . Self structured interview schedule was used to collect the demographic data and self structured osteoporosis knowledge assessment scale was used to asses the level of knowledge regarding osteoporosis among the age group above age group above 60 of khandagiribari. Health behaviour assessment scale is used to assess the health behaviour . The reliability of Tool II self structured knowledge scale was computed by using cronbachs alpha formula which was found 0.85 which is acceptable. Reliability of Tool III of health behaviour was 0.90 which is acceptable. Result: The findings showed that majority of samples was 60-70year It was found that there were need to create awareness programme among the people regarding osteoporosis . The chi square value revealed that there was valid association between the level of knowledge and health behaviour with gender, education, occupation. Conclusion: study concluded that the level of knowledge regarding osteoporosis is good and also positive health behaviour regarding osteoporosis.

Introduction: This study was done to assess the knowledge and health behaviour regarding osteoporosis in khandagiribari. And to find out the association between knowledge and health behaviour with selected socio- demographic variables. Methods and material: quantitative experimental approach and non randomized control group design was adopted. 200 people were selected by purposive sampling technique, who were met the inclusion criteria . Self structured interview schedule was used to collect the demographic data and self structured osteoporosis knowledge assessment scale was used to asses the level of knowledge regarding osteoporosis among the age group above age group above 60 of khandagiribari. Health behaviour assessment scale is used to assess the health behaviour . The reliability of Tool II self structured knowledge scale was computed by using cronbachs alpha formula which was found 0.85 which is acceptable. Reliability of Tool III of health behaviour was 0.90 which is acceptable. Result: The findings showed that majority of samples was 60-70year It was found that there were need to create awareness programme among the people regarding osteoporosis . The chi square value revealed that there was valid association between the level of knowledge and health behaviour with gender, education, occupation. Conclusion: study concluded that the level of knowledge regarding osteoporosis is good and also positive health behaviour regarding osteoporosis.

BACKGROUND AND OBJECTIVES OF THE STUDY: Mental retardation is not a disease but a condition in which the intellectual faculties are never manifested or have developed sufficiently to enable the retarded person to acquire such knowledge. The objective of the study to assess the knowledge score regarding mild and moderate mental retardation of children among the school teacher in urban & rural area, to compare the knowledge score regarding mild and moderate mental retardation of children among the urban and rural school teachers, to find out the association between urban and rural school teacher knowledge score regarding mild and moderate mental retardation and with their demographic variablesandto develop an information booklet regarding mild and moderate mental retardation. METHODOLOGY: A comparative non-experiment is used. The setting is a urban and rural primary schools, Jalandhar. The sample includes 60 primary school teachers selected by purposive sampling technique. The tool consisted: Part 1 demographic variables and Part 2 Self structured knowledge questionnaire. Reliability of the tool was established by using split half method. RESULTS: The findings of the study show that the mean score and SD of rural primary school on knowledge according to area. Definition and epidemiology the mean score is 3 and SD is 0.5, according to etiology the mean score is 5.6 and SD is 0.5, according to types the mean score is 1.2 and SD is 0.833, according to characteristics the mean score is 2.1 and SD is 0.600, according to sign and symptoms and diagnostic tests the mean score is 0.7 and SD is 0.441, according to prevention the mean score is 2.4 and SD is 0.527 and according to management the mean score is 4.5 and SD is 1.236. CONLUSION: Majority (60%) of urban primary school teachers had satisfactory knowledge regarding mild and moderate mental retardation in children while the majority (83.3%) primary school teachers had satisfactory knowledge regarding mild and moderate mental retardation in children.

Synovial chondromatosis is a generally monoarticular disorder characterized by multiple benign nodular cartilaginous formations, arising as a result of metaplasia of synovial tissue. Other names by which this entity is known are synovial osteochondromatosis, primary synovial chondromatosis, synovial chondrometaplasia. The most frequent location is the knee, hip, shoulder, shoulder, elbow, wrist and temporomandibular joint. It can be primary or secondary to a pre-existing chondromatosis. 1-8 It is an uncommon entity with a worldwide incidence of 1:100,000 with greater involvement of males up to 3 times higher. It usually affects people between 30 and 50 years of age, and although its etiology is unknown, it has been associated with chromosomal effects. In studies published between 1996 and 2002, structural alterations were found, which showed a rearrangement of bands 1p13-p22. 1, 2, 3, 9, 10, 11

Introduction: Irritable bowel syndrome (IBS) is a gastrointestinal disorder in which human gut becomes more sensitive and the muscles of the digestive system have abnormal contractions that affect bowel movements. Though IBS cannot be cured as per the main stream medical science, it can be managed through an integrative and holistic approach such as Yoga Prana Vidya System, to minimize the effect IBS has on our overall health and quality of life, as observed in the case presented in this paper. Methods: This paper uses a full depth case study method going through patient’s medical history and records before and after healing, and also taking the feedback from the patient, and evaluating the present health status. Results: Within 10 days of healing and following suggested Yoga Prana Vidya (YPV) guidelines , the patient is able to do all the daily home activities, cook food, go for a walk, travel, better breathing, and practicing forgiveness sadhana which has become an important part of the routine. Her sleep cycle, energy levels are better now. She no longer has episodes of vomiting. The patient is able to eat food well and also has gained some weight which she lost earlier. Conclusions: As an integrative and holistic system of treatment and healing, Yoga Prana Vidya System offers tools and techniques easy to follow and practice, for curing illnesses, and improving overall health and immunity. There is scope for more research to conduct with targeted studies to gain more knowledge about this type of gastrointestinal disorders.

The death rate from COVID-19 is relatively high. In Indonesia, 146,356 patients have died from COVID-19. This study aims to determine the characteristics of patients who died with COVID-19 and the factors that affect mortality in COVID-19 patients. The data was taken at one of the COVID-19 referral hospitals based on medical records. The average age of death for patients with COVID-19 is 57 years with highest age range being 60-65 years. COVID-19 is found in more male corpses than females. Based on the body mass index (BMI) the most are obese patients with the main complaint on admission to the hospital is shortness of breath. Most chest X-rays during treatment were pneumonia, D-dimer levels > 500 ng/ml, leukocytes > 10,000/L, neutrophils > 70%, and lymphocytes < 20%.

The tooth structure does not have ability to regenerate on it’s own until there is introduction of some inducing factors. Several inducing factors present in the form of stem cells, scaffolds and growth factors which thereby, plays role in the formation of enamel, dentin and pulp. In order to stimulate these regenerative factors, certain amount of temperature, pressure and atmospheric humidity should be in control. Specific knowledge of proteins which is present in each of the part of tooth structure (enamel, dentin) is important in order to achieve the final outcome. The present review elaborates about the achievement of tooth structure matrix and organs by usage of specific amount of proteins, growth factors, stem cells.

Introduction: "Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal fulfillment that can occur among individuals whose object of work is other people". Burnout syndrome is considered a mental health problem, with social and somatic repercussions. The objective was: to identify the group of workers most affected by Burnout in the Emergency Department.

Currently, nursing informatics is a part of nursing professional activities. Electronic health records have enhanced the nursing field by bridging the gap from nursing to nursing as a science. Additionally, nursing informatics actively reinforces nursing by providing standard language systems, decision-making support, technological advancements, and enhanced relationships between patients and clinical professionals. As data science continues permanenting in the healthcare systems, nursing informatics promotes the quality of healthcare provided to the patient when applied to routine hospital activities. Notably, nursing informatics has improved data handling and improvement initiatives among the nursing staff. This article aims at assessing the impact of nursing informatics on the quality of patient healthcare. Several benefits are evident, including but not limited to minimization of medical errors, timely diagnosis, and the efficiency of care services, improved communication between the healthcare providers and the patients, and drivers for research and integration of more advanced technologies aiming at improving healthcare quality.

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer- rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture it is regarded as social insult. Atypical presentation and not asking sexual history caused delay in diagnosis diagnosed 10 days after hospital stay. She recovered uneventfully.