Background And Objectives Childhood dental anxiety is one of the most common challenges encountered in pediatric dental operatory, as many children totally avoid the dental examination and treatment due to the same. Visual impact of syringes and needles may hinder the childs cooperation as successful administration of local anesthesia plays a pivotal part in pediatric dental procedures.

Ocular pathologies are, without a doubt, one of the most complicated at the time of regulating medical therapy. Being one of the most relevant sense organs (if not the most important) the use of stem cells in the treatment of metabolic diseases that were previously considered to be slow-progressing, significant improvement can now be achieved.

Introduction: Epidermolysis Bullosa (EB) is an autosomal genetic disorder that characterized by blistering of the skin and mucosa following mild trauma such as frictional trauma. There is no definitive treatment has yet to be developed. The goal of surgical debridement is to achieve a clean wound bed in fastest way, reduce bacterial burden, remove as much nonvital tissue, speed up the healing process, which will shorten the length of stay in hospital.

Shock is a common paediatric emergency. A deep understanding of its mechanism is important for a favorable outcome. Use of analogy can be a useful teaching tool. The stepney (spare wheeled-tire) is a widely known accessory in a motor vehicle. It serves as a temporary replacement for regular tires in emergency situations. Such a role is similar to the compensatory phase of shock. The stepney analogy would be a useful learning aid for medical students and resident medical doctors. It would facilitate the understanding of shock pathophysiology and the need for prompt intervention.

Sartan induced sprue-like enteropathy (SIE) was initially reported as a side effect of chronic Olmesartan use in 2012 and is characterized by chronic diarrhoea and weight loss. The diagnosis is often difficult and requires ruling out of other causes of enteropathy including infectious gastroenteritis, autoimmune enteropathy and celiac disease. A 51 – year – old Caucasian male was admitted to our hospital because of chronic non-bloody diarrhoea associated with severe acute renal failure and electrolyte imbalances. His medical history was only positive for hypertension for which he was on Olmesartan Medoxomil and Lacidipine, both of which were discontinued due to hypotension at admittance. Stool cultures and search for C. Difficile toxin resulted negative, whilst a Colonscopy showed endoscopic and histological signs of aspecific acute colitis. After having responded to i.v. hydration with normalization of the renal function the patient was discharged home with the same medications he was on before admittance. His diarrhoea relapsed and he was readmitted shortly afterwards with acute renal failure and electrolyte imbalances; the anti-hypertensive medications were again discontinued. After having excluded all other causes of diarrohea, including celiac disease and HIV, Sartan – induced enteropathy (SIE) was suspected and then confirmed with an esophagogastroduodenoscopy which revealed a severe erosive duodenitis with multiple duodenal ulcers. The patient again responded to i.v. hydration with normalization of the renal function and Olmesartan was held also at discharge without further relapse of the symptoms. SIE is a rare cause of chronic diarrhoea, weight loss and possible severe renal failure. It could affect the whole gastrointestinal tract and in cases of unexplained non-bloody diarrhea, suspecting SIE is fundamental and should be considered in the differential diagnosis. Discontinuation of the drug is generally sufficient for symptom resolution: in suspected cases with a positive medical history for chronic angiotensin receptor blocker (ARB) use, stopping the drug ex-juvantibus should be undertaken. Further research on the immunopathological mechanisms and how to recognize patients at higher risk of developing this condition is deemed necessary.

Covid-19 is one of the pandemic diseases which was widely spread all over the world. Now the new mutated variant strain, Delta plus, may cause a third wave of the coronavirus. So, all of them are worried about the current situation. SARS-CoV-2 is the virus cause Covid -19 disease. The important Clinical manifestation is loss of taste and smell, dry cough, and sore throat. Widely increasing mortality and morbidity more rapidly. So, we should prevent this spread of infection with appropriate measures

Introduction: Enterobiasis is the most common parasitosis in the world. The literature rarely presents publications on the detection of pinworm eggs in the urine, especially in chronic inflammatory processes of the urinary system. Materials & Methods: We analyzed publications over the past 10 years of detection of this pathology. Results&Discussion: The presented results show the feasibility of detecting enterobiosis by urinalysis, which can significantly improve the diagnosis and treatment of enterobiosis.

Background: Burn scars are associated with significant morbidity ranging from pigmentation, pruritus, pain, contractures and disfigurement to psychosocial impairment. Newer and advanced therapies for the treatment of burn scars have been developed, including lasers, and other topical treatments Case Illustration: An asian woman with history of having hypertrophic scar arising from the edges of previous skin graft for her second degree of burns. We performed contact-mode long pulsed 1064 nm Nd:YAG laser treatment in combination with topical tretinoin and hydroquinone. Ten months after initial combination treatment, the scar showed improvement in term of colour, contour, and consistency. Discussion. Burn scars have tendency to enlarge, hypertrophic and become keloids. Long pulsed 1064 nm Nd:YAG laser helps to reduce hypervascularization that usually found in hypertrophic scars or even keloid. Tretinoin is a derivate of vitamin A which has many different mechanisms in wound healing enhancement. Hydroquinone inhibits melanogenesis and plays role in maintaining pH level in wound healing process. Conclusions: Burn scar responded well to long pulsed 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser treatment. A combination therapy with topical tretinoin and hydroquinone improved the burn scar in term of better color, contour and consistency.

Background. Achatina fulica (A. fulica) snail slime was well known having many advantages especially as moisturizer and antimicrobial, but enzymatic antioxidant properties have not been studied yet. Objective. This study aimed to find the enzymatic antioxidant properties of snail slime extract and to find photoprotective potency in sunburn. Method. This research was an experimental test using randomized post-test only control group design using 75 male BALB/c mice were divided into 15 groups. There were an untreated group, 4 groups were given various doses of snail slime extract topically, 5 groups were irradiated with UVA 30J/cm2 and 5 groups were irradiated with UVB 200mJ/cm2. Skin biopsy were performed 24 hours after irradiated to be analyzed for enzymatic antioxidants properties of SOD, CAT and GPX, and also histologic changes. Data analysis were conducted with one-way ANOVA and followed by post hoc LSD with SPSS 26. Results. A. fulica snail slime contained enzymatic antioxidant properties of SOD, CAT and GPX respectively 40,59 + 5,79U/mL; 13,73 + 6,13 U/mL and 17,64 + 3,84 mmol/L. These antioxidant properties showed role of photoprotector compared to groups that had been radiated with UVA nor UVB. Topical use of snail slime extract significantly increased the level of SOD, CAT and GPX in sunburn model mice (p<0,05). This study also showed snail slime extract could prevent skin damage caused by UVA nor UVB histologically. Conclusion. Enzymatic antioxidants of A. fulica might have a photoprotector potency.

Background: External dacryocystorhinostomy (DCR) is still considered the golden standard for lacrimal surgery. It is a painful procedure that involves intra- and extra-ocular dissection with a high prevalence post-operative nausea and vomiting (PONV). Aims: This study was designed to evaluate the effects of preoperative oral pregabalin on postoperative pain and analgesic requirements in patients undergoing DCR surgery. Design: A prospective randomized double-blind clinical trial. Patients and methods: 100 American Society of Anesthesiologists (ASA) physical classes I and II patients in an age ranging from 18 to 65 years of either sex, had DCR surgery. Patients were divided randomly into two equal groups (each = 50). In pregabalin group, they received two capsules of pregabalin (one at the night of the surgery, the other at 2 hours before the surgery), while patients in control group received two identical placebo capsules. Hemodynamics were monitored, postoperative VAS scores, the time of first analgesic request, total pethidine requirements, and the incidence of PONV were recorded as well. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The pregabalin group exhibited a significant lower incidence of postoperative pain, pethidine consumption and nausea, without any statistically significant differences regarding hemodynamic parameters in comparison to control group. Conclusion: Preoperative oral administration of pregabalin can be a promising modality for alleviation of postoperative pain and reduction in postoperative opioid consumption.

Endotracheal intubation by direct laryngoscopy often elicits a reflex response from the sympathetic nervous system that triggers tachycardia and hypertension. Studies that address the use of esmolol in this context show great heterogeneity, making difficult its applicability in clinical practice. Thus, we evaluated the effect of bolus administration of esmolol on heart rate and blood pressure in adult patients undergoing general anesthesia in elective surgeries. Meta-analysis of randomized, double-blind clinical trials with adults undergoing laryngoscopy/endotracheal intubation for elective procedures under general anesthesia using esmolol or saline. English-language articles in PubMed and ClinicalKey databases with terms such as esmolol, laryngoscopy, endotracheal intubation, hypertension, and tachycardia were included. Duplicate articles, which used esmolol in continuous infusion, without a control group, without results in mean and standard deviation formats were excluded. A random effects model was adopted with DerSimonian-Laird tests and weighted mean difference (WMD) calculation for continuous variables, with their respective 95% confidence intervals (95%CI). Of the 287 studies identified, 13 were selected, accounting for 893 patients (447 in the esmolol group and 446 controls). The use of esmolol was considered a protective factor in decreasing heart rate (DMP = -15.66; 95% CI -18.06 to -13.27 and p < 0.001) and mean arterial pressure (DMP = -12.12; 95% CI -18.32 to -5.92 and p < 0.001) during laryngoscopy and endotracheal intubation. Esmolol reduces the sympathetic autonomic response of adults undergoing laryngoscopy and endotracheal intubation.

Background: Uterine rotation is a common occurrence in pregnancy. However, when the rotation is more than 45 degrees it is termed torsion. Uterine torsion is rare and can complicate pregnancy especially in association with uterine anatomical pathologies, pelvic masses and abnormalities and fetal anomalies. The presentation and management vary and depend on the cause, degree of torsion and age of the pregnancy. The rarity of this condition makes this case report worthwhile. Case Report: We report a case of a 30 year old primigravid woman who booked for antenatal care at 16 weeks gestational age following a 3-year history of primary infertility. The pregnancy was complicated with abdominal pain from red degeneration of uterine fibroids and was managed with pentazocine injection severally in the 2nd trimester. She presented in labour at 39 weeks but the labour was prolonged for 8 hours, having adequate contractions without any significant improvement in both descent and cervical status. She subsequently had an emergency caesarean delivery through a posterior lower segment incision due to an incidental finding of a 180-degree uterine torsion resulting from huge anterior fibroids; with an outcome of a live female neonate that weighed 3.1kg with good Apgar scores. Two pieces of fibroids were removed from the anterior surface that weighed 1.1kg. The post operative and puerperal periods were uneventful. Conclusion: Uterine torsion in pregnancy, a rare obstetric occurrence and infrequently reported complication occurs mainly in the third trimester and may complicate labour. In the presence of significant uterine fibroid, a possibility of uterine torsion may be entertained when the progress of labour is considered poor without any obvious mechanical cause. In such cases caesarean delivery with possible posterior uterine incision may be carried out.

Eosinophilia is a common finding in clinical practice, but when elevated values ??of eosinophils are found, it constitutes a diagnostic challenge. Hypereosinophilic syndrome is a group of rare disorders defined by persistent blood hypereosinophilia >1.5 × 109/l and associated to organ damage that result in a wide variety of clinical manifestations: fatigue with nonspecific skin lesions, to endomyocardial fibrosis, neurological compromise and life-threatening evolution. The prognosis of the disease is variable and depends on the variant and the availability of specific treatment. 1- 2 We present the clinical case of a patient with a history of B symptoms and the presence of persistent erythroderma. The patient underwent several complementary studies, including skin biopsy without presenting a definitive diagnosis. Laboratory with persistence of hypereosinophilia that guided us towards the diagnosis of Idiopathic Hypereosinophilic Syndrome.

This research was aimed at assessing calcium carbide and natural ripened pawpaw (Carica papaya) fruit on the biochemical parameters of the Wistar rats. Twenty four (24) adult Wistar rats weighing between 126.9- 213.3 g was used for this study. The experimental Wistar rats were grouped into three and were allowed to acclimatize for two weeks at libitum. Five (5) ml/kg of natural and calcium carbide ripened pawpaw fruit juice were administered orally. At the end of the four weeks feeding period, the rats were sacrificed through cervical dislocation. Blood was collected by cardiac puncture, using 5ml syringes and 23G needles into blood sample containers for biochemical analysis using the standard biochemical methods. The renal, hepatic, cardiac, heart and lipid profile parameters analyzed were albumin, total protein, urea, creatinine, Alkaline Phosphatase (ALP), Alanine aminotransferase (ALT), total bilirubin, Aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and total cholesterol and were compared with the naturally ripened pawpaw fruit group. All mean values of total protein, total cholesterol, lactate dehydrogenase and creatinine levels of calcium carbide ripened pawpaw fruit juice fed group were significantly higher when compared with the natural ripened pawpaw fruit juice. Meanwhile, albumin, total bilirubin, urea, ALT, AST and ALP levels of calcium carbide ripened fruit juice fed group were lower when compared with the natural ripened pawpaw fruit juice. Statistically, there were no significant differences of albumin and total protein parameters at 95% confidence level (P < 0.05). In conclusion, the elevated levels of creatinine, total cholesterol and lactate dehydrogenase may result to kidney injury, cardiovascular and heart diseases. There is therefore need for institutional and legislative strengthening as well as enforcement to prevent the use of calcium carbide in the ripening of pawpaw and other fruits.

This research was aimed at assessing calcium carbide and natural ripened pawpaw (Carica papaya) fruit on the biochemical parameters of the Wistar rats. Twenty four (24) adult Wistar rats weighing between 126.9- 213.3 g was used for this study. The experimental Wistar rats were grouped into three and were allowed to acclimatize for two weeks at libitum. Five (5) ml/kg of natural and calcium carbide ripened pawpaw fruit juice were administered orally. At the end of the four weeks feeding period, the rats were sacrificed through cervical dislocation. Blood was collected by cardiac puncture, using 5ml syringes and 23G needles into blood sample containers for biochemical analysis using the standard biochemical methods. The renal, hepatic, cardiac, heart and lipid profile parameters analyzed were albumin, total protein, urea, creatinine, Alkaline Phosphatase (ALP), Alanine aminotransferase (ALT), total bilirubin, Aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and total cholesterol and were compared with the naturally ripened pawpaw fruit group. All mean values of total protein, total cholesterol, lactate dehydrogenase and creatinine levels of calcium carbide ripened pawpaw fruit juice fed group were significantly higher when compared with the natural ripened pawpaw fruit juice. Meanwhile, albumin, total bilirubin, urea, ALT, AST and ALP levels of calcium carbide ripened fruit juice fed group were lower when compared with the natural ripened pawpaw fruit juice. Statistically, there were no significant differences of albumin and total protein parameters at 95% confidence level (P < 0.05). In conclusion, the elevated levels of creatinine, total cholesterol and lactate dehydrogenase may result to kidney injury, cardiovascular and heart diseases. There is therefore need for institutional and legislative strengthening as well as enforcement to prevent the use of calcium carbide in the ripening of pawpaw and other fruits.

Patients with end-stage kidney disease undergoing hemodialysis often experience Thirsty and reduce thirst in patients undergoing hemodialysis, among others, by chewing low-sugar gum and sucking ice cubes. stone to decrease thirst in chronic renal failure patients undergoing hemodialysis. This type of research used a quasi-experimental design with a two-group pre-post design, with a total sample of 34 people divided into two groups of 17 people in the chewing gum group and 17 people in the ice cube group. The results of the study before chewing low-sugar gum felt thirsty were 14 people (82,4%) and 3 people (17,6%) who felt very thirsty, while before chewing ice cubes, 16 people felt thirsty (94,1%) and 1 person (5,9%). Giving low-sugar chewing gum decreased the thirsty of as many as 14 people (82,4%) and those who did not decrease thirsty as many as 3 people (17,6%), while after sucking ice cubes, the results showed a decrease in thirst by as much as 16 people (94,1%), and 1 person (5,9%). The results of the Mann-Whitney test showed that there was a difference in the effectiveness of chewing low sugar gum and sucking ice cubes in reducing Thirsty where sucking ice cubes was more effective than chewing low sugar gum with a p-value of 0,000. Sucking ice cubes is more effective in reducing Thirsty compared to chewing low-sugar gum. Can increase knowledge and insight for patients with chronic kidney failure in dealing with thirst.

Cruvelier-Baumgarten syndrome is a rare disease that causes portal hypertension in association with unclogged umbilical or paraumbilical veins, hypoplasia of the intrahepatic portal system, and liver atrophy with minimal or no fibrosis. Patients with this condition experience the classic signs of portal hypertension such as gastrointestinal bleeding, ascites, and encephalopathy. Frequent clinical manifestations are the symptom of "jellyfish head" and venous murmur over the umbilical region due to the presence of large umbilical and paraumbilical veins. In the presented clinical case of Cruvelier-Baumgarten syndrome type II in combination with splenic artery arteriovenous fistula, pathological changes were not pronounced. There was no "jellyfish head" symptom, but a venous murmur was heard in the umbilical region. The patient complained of moderate pain in the epigastrium, right hypochondrium. Examination of the patient, which revealed, in addition to the typical manifestations of this disease, also multiple SAVFs, as well as angiography data regarding pressure in the umbilical vein - 5 mm Hg, determined the tactics of treatment in the volume of endovascular occlusion of the splenic artery branches, which was successfully completed. As a result, there was a decrease in pressure in the portal system and a sharp decrease in discharge through the recanalized umbilical vein into the basin of the inferior vena cava, which made it possible to level out complaints. At the control examination two months after treatment, the patient had no complaints. A review of the literature on the Cruveilhier-Baumgarten syndrome and disease is presented.

An intestinal obstruction can be divided into mechanical or functional of the small intestine or the large intestine. This can happen if the lumen of the intestine is partially or completely blocked. Within the common clinical picture you can find abdominal pain, nausea, vomiting, constipation to constipation and abdominal distension. Small bowel obstructions occur more frequently than large bowel obstructions. One of the classifications to be able to divide them is in complete, closed handle or partial. The prompt identification of this pathology as well as indicating an opportune treatment is key for the survival of the patients.

ackground: Antenatal care is a basic but specialized care given to every pregnant woman for a positive pregnancy experience and better outcome. Adequate health education, adequate provision of basic health facilities in every community and affordability of the services will go a long way to improving the acceptability and uptake of this essential services with resultant improvement in the feto-maternal outcome. Aim: The aim of the study was to determine the level of utilization of antenatal services among the market women in Abakpa Main Market of Abakalikki, Ebonyi State. Methodology: The study was a cross-sectional study of consenting market women of child bearing age who were either pregnant or had had a baby in the past 5 years. Data analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software Version 20.0 for Windows. Results were presented using tables, frequencies and percentages. Results: The result from the study showed that of the 200 women sampled, 165(82.5%) attended ANC in a certified health facility whereas 35(17.5%) did not. It also revealed that 195(97.5%) of the women were willing to deliver or delivered in a certified health facility while only 5(2.5%) were willing to or delivered in their home, traditional birth attendants or a church. Conclusion: Antenatal care is a critical aspect of maternal health with implications on the eventual feto-maternal outcome. Proper health education and provision of basic health facilities in every community will improve ANC uptake among our women for a positive pregnancy experience and better pregnancy outcome.

An interventional study attempted to evaluate the impact of brain gym exercise on mitigating stress levels in high school pupils in a selected government high school,odisha with objectives to measure the level of stress among high school students, to evaluate the effect of brain gym exercise on mitigating the degree of stress on high school students in order to determine the relationship between stress levels and certain demographic characteristics. Total 120 samples were choosed by using proportionate stratified random sampling techniques. Self-structured student stress scale was utilized to determine the amount of stress among the participants. Brain gym exercise was given for 15 days. The study result demonstrated a statistically significant difference in Levels of stress pre- and post-test in the experimental group at p-value?0.0001. Level of stress was significantly associated with gender as chi square value (12.513) at p value (.003) and education of father as chi square value (10.213) at p value (0.001) and fathers profession as chi-square value (14.506) but no significant association with the other socio demographic variables. The study revealed that the brain gym exercise was efficient in stress reduction. Level among high school students.

Intermittent self-catheterization was introduced as an alternative to reduce the risk of developing cancers of the bladder in patients with indwelling catheters. Since then, case studies have shown that the risk is not entirely mitigated. Squamous cell carcinoma of the bladder and urothelial cell carcinoma with squamous differentiation are rarely reported as consequence of ISC. As such, these diagnoses are not generally considered as risks and alarm symptoms are often disregarded. We report a case of urothelial cell carcinoma with squamous differentiation as a result of decades of ISC.

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They predominate between the fifth and sixth decade of life, due to the higher incidence of neoplasms and complex biliary diseases, with higher incidence in countries with temperate climate. Most are secondary to biliary or gastrointestinal tract infection. It is often preceded by symptoms that vary from days to two to three weeks, with fever in 90% of patients, followed by hepatomegaly, attack of the general condition, weight loss, anorexia and vomiting and finally hepatodynia. Mortality rates vary in various series from 5 to 10% in North America and Europe to 3 to 30% worldwide. The difference probably lies in the pathology responsible for the condition. Mortality has been shown to be higher in older patients with multiple comorbidities, including cirrhosis, renal failure, sepsis and cancer. Patients treated with aspiration or percutaneous drainage have half the mortality of those treated with antibiotic therapy alone.

Background: The World Bank and the World Health Organization (WHO) predict that depression and coronary heart disease will be the largest causes of global health burden and disability by the year 2020. Although no countrywide study has been done on the prevalence of Post myocardial infarction (MI) depression in Ethiopia; It is thought to be higher than the possibly conservative rates of major depression in the general population as reported by multiple studies. Objectives: To assess the prevalence of depression and associated factors among Post MI out- patients at a teaching hospital, Addis Ababa, Ethiopia. Methodology: A hospital based cross-sectional study was conducted among 164 MI patients on follow up at SPHMMC Cardiology OPD. Patient health questionnaire 9 was use to screen depression. Data was collected from September 1 to October 15 2020. The data was entered, analyzed and interpreted using SPSS version 25 software. Result: A total of 164 participants were enrolled in to the study, about 88(43.7%) of the participants were females. The mean age was 44.9 (S.DS±1) years. Prevalence of depression was found out to be (12.7%). Type of MI was the single independent factor found to have significant association with depression, having NSTEMI has 2.53-time hire risk of depression compared to STMI. (p < 0.05). Conclusion: The study found a high prevalence of depression among MI patients. Therefore, developing early screening and detecting strategies and making it part of standard management for patients with MI is of a high value.