Dermographism is the most common induced dermatopathy in the world, presenting in multiple age groups and even with different pathologies such as comorbidities, its clinic, although variable, can present as the presence of erythematous lesions on the skin. literally this pathology means "writing on the skin", which can be alarming for some patients.

Botulinum toxin is an injectable neuromodulator derived from neurotoxins produced by the bacterium Clostridium botulinum, which causes botulism. The human face is made up of a complex network of muscles that work together to create facial expressions and perform essential functions. Clinicians who understand facial anatomy and the functional relationships between muscles in the face and neck can use botulinum toxin safely to selectively weaken specific muscles, resulting in favorable cosmetic results

Background: Community Extraordinary events need to be anticipated by preparing a team to respond quickly to exceptional circumstances and outbreaks at each health center, and it is necessary to increase the capacity of the special personnel of the Rapid Action Team (RAT). What is the preparedness of the fast-moving team to respond to the prevention and control of outbreaks at the Public Health center.

A skin autograft is described as the transfer of skin without the aid of a blood supply from the donor location to the recipient site. The epidermis and portions of the underlying dermis from the donor location are transferred using split-thickness skin grafts (STSGs). The whole layer of skin is harvested for full-thickness skin grafts (FTSGs) and used as the transplant. The installation methods and usage of STSGs are discussed above. Graft movement, which impedes neovascularization and promotes fluid accumulation under the transplant, which can result in infection and inadequate revascularization, is the key factor in skin graft failure.

BACKGROUND: Nowadays, mobile phones are constantly being improved by enlarging upon their functionalities, which in turn increases the tendency of overuse and addiction. This study aimed to find the prevalence and factors associated with mobile phone addiction (MPA) among university students in Bangladesh.METHODS: This study recruited 379 participants by a self-administrated online based e-questionnaire using a cross section design. Leungs Mobile phone Addiction Index Scale was used to assess MPA. In addition, logistic regression analysis was used to explore the associated factors for MPA.RESULTS: The overall prevalence of MPA was 42.2 % among the current university students. However, the addiction rate was 45.7 % among <25 years old participants. Spending time on the social media sites and lose sleep due to late night internet device activity were the reasons for MPA among university students in Bangladesh. Participants age less than 25 years and studying in undergraduate level had a higher chance of MPA.CONCLUSION: This study exposed that the prevalence of MPA was comparatively higher among younger participants. Spend time on social media sites and lose sleep due to late night internet activity are the most significant determinants of MPA. Thus, raising awareness among the younger generation is most important to reduce MPA. The findings of the study can be used to support health and educational organizations design programs that will help prevent MPA among university students in Bangladesh

Complications following reconstructive or aesthetic breast surgery are important considerations for women pursuing these options. Common complications of breast reconstruction using implants and expanders include capsular contracture. Knowing this pathology is necessary due to its prevalence in patients undergoing breast interventions. Preventive actions must be taken, as well as optimizing some techniques and knowing risk factors in patients to reduce the incidence as much as possible.

Dupuytrens contracture is a reasonably frequent condition characterized by palmar fascia fibrosis. It is a benign fibroproliferative disease of the palmar fascia that progresses slowly. The treatment aims are to restore finger mobility and to determine if surgery or other procedures are required. The therapy chosen is determined on the severity of the ailment. There are now many approaches for treating individuals with Dupuytrens contracture; each case must be carefully selected to provide the most benefit, limit morbidity, and avoid recurrences.

A wound is a disturbance of the skis and soft tissue architectures normal structure and function. Prior to further wound treatment, wounds with devitalized tissue, contamination, or leftover suture material benefit from debridement. Wound base preparation allows for the orderly healing and regeneration of injured tissue and may improve the performance of specialist wound care products and sophisticated biologic tissue replacements. There are now many approaches for treating individuals with Dupuytrens contracture; each case must be carefully selected to provide the most benefit, limit morbidity, and avoid recurrences

Background: Spontaneous bacterial peritonitis (SBP) is one of the most common complications in cirrhosis with ascites, which is associated with a high mortality. Various studies have shown that the prevalence of PBS ranges from 20-30% in patients with cirrhosis and ascites. Not in all cases it is accompanied by obvious symptoms, which makes early diagnosis difficult.

Acne fulminans or acne malignant is a rare skin pathology that presents in the form of painful, ulcerative, disfiguring acne, usually accompanied by systemic symptoms such as fever or polyarthralgia. Arriving even in serious cases to cause bone injuries and alterations in laboratory tests. This condition is usually resistant to the antibiotics usually administered, which is why it is so important to have a multidisciplinary team that is in coordination for the care of affected patients.

Most mild burns may be treated well in an outpatient environment and recover with little intervention. An precise categorization of burns is essential to ensuring effective treatment. Any non-superficial burn should be treated with a topical antibiotic to avoid infection. Although partial and full-thickness burns frequently require dressings, superficial burns typically do not. Especially in an emergency situation, a simple gauze patch offers enough burn protection. Increasing burn depth and contracture, monitoring for symptoms of infection, and providing appropriate analgesia are all parts of follow-up treatment. All suspected partial or full-thickness burn infections require prompt treatment, which may include hospitalization and parenteral antibiotics. Burn infections can increase the depth and breadth of a burn, turning a superficial partial-thickness burn into a deep partial-thickness or full-thickness burn in addition to producing sepsis.

With the aim of informing the first contact physician about the hypertensive states of pregnancy, we carried out this bibliographic review. Sources in English and Spanish were consulted for the writing of this article. Hypertensive status of pregnancy refers to a group of disorders that constitute, as a group, one of the most common complications of pregnancy [1]. The incidence of this group of disorders is close to 1 in 10 pregnant women [2], due to its high frequency, it is important for all doctors to know about these states, for their early identification, particular diagnostic method to each of them and the treatment of choice. Thus through prevention at the first level of care and its treatment at the second level of care, the incidence of both maternal and perinatal complications is reduced, generating a benefit to the Mexican public health

Crohns disease is an inflammatory bowel disease of unclear etiology, associated with an excessive immune response with stages of remission and activation. It can affect the entire gastrointestinal tract from the mouth to the anus; the most frequent symptoms are abdominal pain and diarrhea. The impact that lifestyle modification and good treatment have on the patients life is so crucial that primary care physicians must learn to recognize it and not confuse it with similar gastrointestinal pathologies.

A gastric bezoar is defined as a foreign body resulting from the accumulation of ingested material, most commonly found as a hard mass or concretion in the stomach. It has been described in patients with psychiatric illnesses. We present the case of a patient with tricobezoar that is composed of hair that required surgical extraction.

The vacuum-assisted closure (VAC) technique is a relatively recent procedure that consists of administering negative pressure on the wound in conjunction with a closed environment that decreases edema, facilitating vascularization, oxygenation and healing. In addition, it promotes the formation of granulation tissue. We present the case of an 18-year-old woman with a bloody wound on the anterior side of the left thigh. Surgical washing and negative pressure therapy were performed with an artisanal VAC cure system as there were no commercialized systems, performing the healing technique in a simple and cheap way, using materials easily acquired in the hospital environment. Given the high incidence of bloody injuries and the limited availability of negative pressure systems marketed, it is proposed to carry out an artisanal system that can be carried out in any unit.

The American Cancer Society estimates that 60,050 cases of endometrial cancer will be diagnosed in 2016 and that 10,470 will die from endometrial cancer during 2016. Since 1988, incidence rates have increased by 1.3 per cent per year for women under 50 and by 1.9 per cent per year. In women age 50 and older, uterine cancers are usually treated with surgery, radiation, hormones, and/or chemotherapy. Uterine cancer is the most common form of gynecologic cancer. Surgery is the mainstay for staging and optimizing treatment for women with endometrial carcinoma. The surgical approach has evolved rapidly since the late 1980s with the introduction of laparoscopy in the surgical staging of endometrial cancer. An alternative to conventional laparoscopy or robotic surgery is single-port Laparoendoscopic 3-incision surgery which further enhances the cosmetic benefits of minimally invasive surgery, avoiding the potential morbidity associated with multiple incisions. Since it has been observed that it offers greater visibility and accuracy of the area of operation. Althoughmost of the advantages are in cases, such as patients with previous abdominal surgeries and obesity

Bacterial skin infections are processes that are produced by the direct or indirect presence of different bacteria, which can infect the skin and/or its annexes. Knowledge of these processes is relevant because, although there are some unimportant and exclusively local infections, there are others that can lead to systemic diseases and lead the patient to a septic state and, if complicated, death. This work tries to expose the clinic and the characteristics of impetigo on the subject of a case. Bacterial infections mainly affect the leg and foot, however face involvement is important due to its clinical implications

Background : Cleft lip and cleft palate are the most common congenital craniofacial anomalies treated by plastic surgeons. The incidence of cleft lip and palate is higher at lower socioeconomic levels. Hospital Social Responsibility (HSR) in Gatot Soebroto Central Army Hospital provides free cleft lip and palate surgeries to those who need it the most. The HSR services still need to be evaluated, to get an overview of epidemiologic profile of cleft lip and palate patients, and to improve the services itself. Materials and Method: The authors conducted a retrospective descriptive study based on online data of Smile Train HSR RSPAD Cleft Center from period of January 2015 to December 2019. All patients presented with cleft lip and/or palate were included. Results : Of all 713 patients in total; The gender distribution male 62.2% (444/713) was higher than female 37.7% (269/713). Most of the patients came from Java Island 77.5% (553/713). 685 were primary surgeries, 28 secondary surgeries. Among the primary surgeries, lip repair has the highest numbers 71.6% (491/685), followed by palate repair 27.2% (187/685), and alveolar bone grafting 1% (7/685). The most widely used surgical technique in lip surgery was the Millard 50% (345/685), while the most widely used surgical technique in palate surgery was the Bardach technique 22.9% (157/685). The median age for the primary lip repair patients was 1 year (range, 3 months to 60 years), and the median age for the primary palate repair patients was 4 year (range, 7 months to 26 years). Among secondary surgeries, lip revision with Millard technique was the highest (82.1%), followed by scar revision 3.57%, fistula repair (7.1%). The most common diagnosis was unilateral cleft lip (left 34.4%, right 13.2%) and followed by complete cleft palate (22.7%) Conclusion: Male patients were more dominant than females. The most common diagnosis was unilateral cleft lip. Incomplete diagnostic data and clinical photos of patients make it difficult to determine the complete diagnose of cleft lip and palate.

Ayurveda is a great science. If it is followed properly gives miraculous benefits. These days COVID -19 is an emerging disease as a pandemic with various signs and symptoms. A lot of Ayurvedic whether herbal or herbo-mineral drugs are used for the treatment as per the protocols suggested. Among all these opportunities in front of doctors and vaidyas Ayurveda which was emanated since times from our ancient sages is perpetuating more than before as to serve the humanity. There are a lot of preparations used these days for COVID-19 by the Ayurvedic physicians. Sometimes common people use these preparations as self-medications without knowing the side effects. The word “Natural” in case of herbals equivalent to “safe” is a misleading perception. Herbs are neutraceutical in nature and are vastly available in market known as functional foods. These are used as immunity boosters namely Turmeric, Dry ginger, Shigru, Ashwagandha, Pippali, Kali marich, Mulethi, Haritaki, Dalchini & Tulsi. All the herbs can said to be plethora of immunity boosters if used with utmost care

Primary peritoneal tumors share a common anatomical site and therefore their clinical manifestations are very similar. When peritoneal masses are detected, the tentative initial diagnosis is secondary to metastatic disease, which has been determined most frequently in the peritoneal cavity. However, primary peritoneal tumors should always be included in the differential diagnosis. Among the primary malignant peritoneal neoplasms, mesothelial tumors have been identified (malignant mesothelioma, well-differentiated papillary mesothelioma, benign cystic mesothelioma, adenomatoid tumor of the peritoneum), epithelial-type tumors (primary peritoneal serous carcinoma, primary peritoneal serous borderline tumor), tumors of the smooth muscle (disseminated peritoneal leiomyomatosis) and tumors of uncertain or undetermined origin (desmoplastic small round cell tumor, peritoneal solitary fibrous tumor)

Hypertensive crisis in children is relatively a rare condition and the prevalence is currently unknown (1). The most common etiology of hypertensive crisis is secondary hypertension, while primary hypertension is less common (2)(5)(7). We performed a case report of 13 years old boy with hypertensive crisis caused by primary hypertension. He came to emergency unit of our hospital due to epistaxis, nausea, vomiting and abdominal pain. On the physical examination we found that the blood pressure was 180/110, his body weight was 60kg, the height was 154cm, and the BMI was 25,2 (categorized as overweight). The history of hypertension in his family was positive. On the further examination, the results of the laboratory finding, urinalysis and thorax x-ray was within normal limit. In the emergency unit, the patient was treated with nifedipine 5mg sublingual, furosemide injection 30mg. Patient was hospitalized at observational unit and discharged in fifth day with improvement and the blood pressure was 120/80

Fear is a basic, universal, and primary sensation; its function is to protect against risk situations; without fear, people would act recklessly and endanger their lives. Fear acts as a regulator of our behavior, warning us of dangers and avoiding them when detecting a threat, this is interpreted as such when damage to physical integrity is involved as well as damage against reputation self-esteem, self-concept, or security, depending on the idea and beliefs about it. The amygdala is the structure responsible for this sensation. Hereunder, this text will show a review about the location, structure, functioning and importance of the amygdala, as well as the relationship between this structure and fear through studies carried out in animals and humans.

Ectopic pancreas is a rare embryological abnormality apparently not in association with others. Stomach and duodenum are the most common organs involved. Symptoms are nonspecific.Patients may complain of dyspepsia, abdominal pain or intestinal obstruction. Diagnosis can be very challenging due to the rarity of the disease and the absence of specific symptoms and radiological findings. Here we report a case of Heterotopic pancreas in a gastric tissue in a 23 year old woman admitted to the emergency department due to acute upper gastro-intestinal symptoms.Endoscopic ultrasonography revealed submucosal gastric lesions. The patient underwent abdominal computed tomography, that showed gastric mass originating along the lesser curvature of the stomach. According to the patients symptoms, family history and radiological findings, the patient was scheduled for a surgical resection.In this case, gastric ectopic pancreas was found on routine histopathological examination. Clinical presentation of ectopic pancreas can be challenging, especially in an emergency setting. Diagnostic-therapeutic laproscopy should be considered in symptomatic patients.

Basal cell carcinoma is the most common skin cancer, especially in Caucasians. The head is the most common location, however, in exceptional cases it can occur in areas where there is little sun exposure, it is usually aggressive in most cases. Each time there is an increase in the youngest basal cell, it presents different types: Nodular, Superficial, Populations of incidence. Pigmented, Morpheiform or Infiltrating or Sclerosing clinical carcinoma and Fibroepithelioma. It is usually characterized as a locally invasive, aggressive and destructive carcinoma with a high capacity to metastasize. Treatment consists of surgical removal of the lesion, however in advanced cases management will have to be multidisciplinary.

The abnormal growth of the spleen is called splenomegaly, this finding is a challenge when determining its etiology for the first contact physician due to the wide range of diagnostic possibilities. Infectious, tumoral, and hematologic aetiologies should always be sought among the main aetiologies. In this case, we present a 45-year-old male patient who came to the clinic for the first time because he presented with a palpable and non-painful abdominal tumor of long evolution, with a diagnosis of chronic myeloid leukemia for 6 years, with poor adherence to treatment. Its diagnosis is based on obtaining images through methods such as tomography or magnetic resonance imaging to confirm the presence of splenomegaly, but ultrasound remains the technique of choice in Primary Care. Through clinical suspicion and performing an ultrasound in consultation, we arrive at a clinical diagnosis

When an air-filled loop of the sigmoid colon coils around its mesentery, this is referred to as sigmoid volvulus. When the degree of torsion surpasses 180 and 360 degrees, respectively, the intestinal lumen is obstructed, and vascular circulation is impaired. A sigmoid volvulus is suspected in individuals who have stomach discomfort, nausea, abdominal distension, constipation/obstipation, and a distended and tympanitic belly on physical examination. To confirm the diagnosis of sigmoid volvulus and rule out alternative causes of stomach discomfort and intestinal blockage, we do an abdominal computed tomography scan. The treatment of individuals with sigmoid volvulus is dependent on the presence of warning symptoms.

Menopause is just puberty’s evil sister. Geriatric women are passing through various physiological changes of body like premenopausal symptoms, perimenopause and post menopause. Menopause is a normal physiologic process in ageing women. Although many women over age 65 have persistent menopausal symptoms, there are limited data to guide therapy among older women. Approximately 9-16% of women over the age of 65 continue to have menopausal symptoms and 13.7% of those women are using some form of menopausal hormone therapy (HT). In geriatric age cognitive disturbance, urinary symptoms, vasomotor symptoms, psychogenic symptoms, sexual dysfunction, mood changes etc. have been linked to hormonal changes and increasing age among females. These changes are generally due to disturbed Vata dosha and Dhatukhaya. In geriatric women it is better to balance aggravated doshas so that the intensity of these diseases will be far less. This can be restrained with the unique therapeutic method known as Rasayana chikitsa which minimize the intensity of problems occurring during this phase of life. The focus of the article is to describe the pathophysiologic symptoms related to menopausal transition and to review the effect of rasayana therapy in geriatric women with special care of menopausal symptoms. If implemented properly Rasayana can give a better result instead of hormonal replacement therapy.

Multiple sclerosis and osteoporosis are diseases that its comorbidity usually affects on postmenopausal women, certain evidence shows share pathogenic ways, and inclusively it’s been proved that peri-pathogenic situations with certain treatments can predisposed patients with this pathology neurodegenerative to imbalance the bone density system. In this article we stablished what the multiple sclerosis and osteoporosis are, we investigate if there’s a relationship between them and tried to explain more than a “casual statistic of comorbids” , also we use as an example this situation with an archetypal case report that represent exactly this type of patients.

Splenectomy can treat conditions characterized by hemolysis or thrombocytopenia caused by autoantibodies or splenic reticuloendothelial function, as well as disorders characterized by massive splenomegaly and hypersplenism with cytopenias, such as hereditary spherocytosis, transfusion-dependent thalassemia, immune thrombocytopenia, autoimmune hemolytic anemia, splenic marginal zone lymph Splenectomy is no longer used for Hodgkin disease staging and is typically avoided in autoimmune lymphoproliferative syndrome, hereditary stomatocytosis or xerocytosis, cold agglutinin disease, paroxysmal cold hemoglobinuria, Gaucher disease, and cirrhosis-related hypersplenism

The hypoglossal canal is a permanent element of the human skull (Wysocki et al. 2004). The hypoglossal canal is situated occipital bone (Sakamoto 2019). Variations can be found in this canal. Sometimes it is divided by a spicule of a bone leading to a variant as a double hypoglossal canal (Zaidi, Gupta, and Usman 2011). Knowledge of variations in anatomy is important in both surgery and anatomy.

Maxillofacial surgery involves an operation to correct a disease, injury or defect of face, jaw or mouth. Recently some strategies have been developed for minimizing postoperative discomfort after maxillofacial surgery, including the use of pharmacological therapy and alternative medicine. However, patients still suffer some pain, swelling, and limitation in mouth mobility and other symptoms after surgery. Reducing malaise and postoperative complications is a critical issue for Plastic Reconstructive doctors. Zinc is a group II b metal that is involved in diverse physiological processes such as growth, immune system modulation and tissue repair, significant reduction in the use of analgesics for oral pain, acts as anti- inflammatory agent can promote wound healing, increases the number of osteoblasts by stimulating protein synthesis in the osteoblastic cells and has many impact on the bone healing process.

Background: The number of elderly patients with malignant head and neck tumors has been rising, resulting in an increase in the number of elderly patients requiring complex reconstructive surgery. The mandible is an important part of the human face, so in cases of mandibular reconstruction, the surgeon has a major responsibility to maximize function as well as cosmetics. The free fibular flap has been commonly used for mandibular reconstruction with its own indications, advantages and disadvantages. Methods: A 68-years-old Man with chief complaint a not healing lesion on the mandible. The patient was diagnosed with oral and mandibular squamous cell carcinoma. The patient underwent total jaw resections and after that a free fibular flap was used immediately for mandibular reconstruction. Result: On post-operative days 3- 6 free fibular flaps demonstrate colour and fine aesthetic appearance. There were no major post-operative complications. There no signs of infection, vascular crisis and haematoma were observed. Conclusion: The free fibular flap and de-epithelization technique are a safe and dependable options for comprehensive functional and aesthetic mandibular defect in elderly.

The true knot of the umbilical cord is a pathology with a relatively low incidence. However, it is associated with the risk of loss of fetal well-being and in severe cases with perinatal death. There are both maternal and fetal risk factors, with different associated perinatal outcomes. Prenatal diagnosis is a challenge for the attending physician and almost all cases are findings at birth once the cord has been observed. However, over time, ultrasound methods have been developed to search for it in cases where suspicion is high. and most cases are findings at birth, however, today ultrasound methods are available for their intentional search, mainly in patients with unidentified risk factors. Similarly, it should be suspected in the presence of an altered cardiotocographic record or one that shows a non-reassuring pattern, especially when there is no response to established intrauterine resuscitation maneuvers, such as left lateral decubitus position, supplemental oxygen and maternal hydration.

Upper gastrointestinal bleeding (UGIB) is a highly prevalent medical-surgical emergency that must be treated early due to its high morbidity and mortality. It presents as bleeding from the esophagus, stomach or proximal duodenum, and is divided into non-variceal and variceal etiology. Among non-variceal ulcers, peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal-type hemorrhages, gastroduodenal varices stand out, which are a consequence of increased portal pressure. The incidence of UGIB worldwide varies considerably between literature and mortality between 5 and 14% according to different studies. Unfortunately, there are no reliable national figures for incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology in order to be assertive in the suspicion, diagnosis and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic management, since early intensive resuscitation can reduce morbidity and mortality in patients with upper gastrointestinal bleeding.

Botulinum toxin, the causal agent of botulism, is employed in therapeutic settings for a number of purposes. Botulinum toxin injections address aesthetic issues induced or worsened by muscle contraction by controlling local neurotransmission. Therapy has a transient impact; muscle recovery is generally clinically visible a few months following treatment. Improper injection placement or toxin diffusion to unintended locations following injection might result in severe muscular weakening, which can cause temporary deformity or functional problems. Some aesthetic flaws, such as eyelid ptosis and a perplexing brow, can be corrected with therapeutic procedures. In other circumstances, progress is contingent on the botulinum toxins declining action over time.

Delirium or acute confusional syndrome is a common problem in geriatric patients, although its diagnosis is often overlooked, especially in its hypoactive form. Risk factors for delirium are previous cognitive alterations and certain comorbidities, different environmental factors and acute organic alterations typical of critically ill patients. Delirium is associated with increased short- and long-term mortality, to the prolongation of mechanical ventilation, to prolonged stays in the Intensive Care Unit (ICU) and in the hospital and to cognitive deterioration after hospital discharge. In recent years, specific tools have been developed for the detection of delirium in ICU. The implementation of specific interventions on certain risk factors can reduce the incidence of delirium in hospitalized patients. The treatment of delirium it is based on identifying and correcting the underlying causes, establishing support measures and, sometimes, pharmacological treatment to control symptoms. Haloperidol is the first-line drug for the control of delirium, since experience with atypical neuroleptics, such as olanzapine and risperidone, as well as with other drugs, it is insufficient to be able to make recommendations on their use. Neuroleptics can have serious side effects that must be taken into account. In cases with agitation, the simultaneous use of benzodiazepines or propofol may be necessary and, sometimes, in a temporary and protocolized manner, the use of physical restraints.

Aromatherapy, that employs essential oils extracted from numerous plants and herbs, is wide used and is turning into a significant complementary and alternative medicines. Among numerous complementary and various medicines, inhalation aromatherapy has particularly received attention principally for its effects of relaxation and improvement of emotional or psychological conditions, and a few clinical trials have recommended the potential of aromatherapy for anxiety, insomnia, stress, and pain. In in vitro and in vivo experiments, some essential oils were recommended to act as anti-inflammatory drug, anti-viral, anti-tumor, anti-hyperglycemic, anti-carcinogenic agents, support treatment of wounds, and facilitate healing. Lavender volatile oil is anticipated to possess a useful result on wound healing as a result of some evidences for its result were already rumored. The last study rumored that topical treatment with lavender oil on aphthous ulceration showed a big ulcer size reduction as compared to control in both an animal experiment and a clinical study.

Chagas disease is a zoonosis transmitted by Trypanosoma Cruzi, which has become a public health problem worldwide. The infection can be acute, chronic phases and reactivations, characterized by heart involvement. We report the case of a 33-year-old woman with stabbing chest pain, as well as hemiparesis in the left arm managed for 8 weeks, with persistent chest pain, electrocardiogram (ECG) showing a heart rate of 40 bpm. She is referred to a cardiologist who requests a Holter which shows pauses of 5.4 seconds and a transthoracic echocardiogram with LVEF 56%, PASP 24 mmHg; anti trypanosoma cruzi IgG antibodies were requested with a positive result, starting management based on nifurtimox; candidate patient for management with a double-chamber pacemaker, with remission of symptoms. In recent years, our knowledge about Chagas disease has expanded, electrocardiography is the most useful individual examination technique for these patients. Late manifestations include sinus node dysfunction leading to severe bradycardia, high-grade AV block, etc. Chagas disease should be suspected in all patients with an epidemiological history compatible with symptoms of cardiac involvement. and we believe that active intervention in endemic areas of the disease is especially relevant.

Gastroschisis has been defined as a malformation of the abdominal wall that classically presents as a visceral herniation with the presence of an intact umbilical cord and absence of a membrane covering the abdominal content. Its exact etiology is unknown; however, it is recognized that it presents a multifactorial inheritance pattern. Recently, an increase in the number of cases has been observed worldwide, particularly in Mexico, which is why some authors propose that It is a silent pandemic that has not been monitored. The understanding of the etiological factors of this pathology can help to understand a little more the factors to which we are predisposed in our environment.

Background: Dermoid cyst is a tumour mass that is often encountered in daily clinical practice. Histological examination showed a layer of keratinized squamous epithelium. Dermoid cysts in the craniofacial region comprise about 7 percent of all dermoids. This case report will review a 21-year-old patient with a right temporal dermoid cyst.Case report: A 21-year-old man came to the emergency department of Bendan Hospital, complaining of a lump on the right side of his head, the lump had been there since the patient was child, then it grew. Non-contrast CT scan of the head showing the impression of a lipoma on the scalp of the right occipital region. When the patient underwent excision of the tumour and histopathological examination of the tissue was performed, the result was a dermoid cyst.Discussion: Dermoid cyst is known as a benign congenital tumour that grows early. Research prefers to use a direct approach to the patient, given that proper scar management is part of the follow-up Conclusion: Dermoid cysts have until recently been considered a congenital lesion, but not all of them can be diagnosed at birth.

Background: unforeseen events, such as a pandemic crisis, and disasters sometimes spontaneously arise in the healthcare organization. While it is recommended that the management should formulate robust plans in readiness for such crises, there is little evidence on the current preparedness of the strategic human resource management in the crisis preparedness in Saudi Arabia. Purpose: this research was conducted to analyze the role and preparedness of strategic human resource planning in the crisis management in Saudi Arabia. Methods: quantitative cross-sectional research was conducted in Saudi Arabia. Data was collected from a sample of 68 participants, who were healthcare workers in different occupations, including doctors, nurses, receptionists, management and risk management. the questionnaire used in data collection was adapted from a previous research study. The analysis of data was then performed using the descriptive statistics of SPSS for evidence-based conclusion. Results: this study noted that most of the healthcare service providers through the strategic human resource management mostly read the emergency response plan for strategic crises management annually (71%) and 29.41% never read them at all. However, 91% have an emergency response plan crises management, and 60.29% have a summarized version of the risk management. It was also established that 38.23% of the healthcare workers participate in the collective training with the local authorities annually and 79.41% do update their contact details for easy access. Conclusion: overall, the preparedness of the strategic HRM in healthcare organizations to deal with crisis varies from case to case. Nevertheless, there is a need for improving the healthcare crisis preparedness among the human resource management in Saudi Arabia.

The covid-19 Pandemic affected worldwide including Indonesia and obliged each part of society to handle its spread. The implementation of screening regulations for suspect cases by Polkesjati Covid-19 Handing Task Force had been established for a year since the first day of infection happen. However, the report has never been implemented. This study was conducted to describe a one-year implementation of screening suspect cases in Polkesjati. This study was a narrative-descriptive study using secondary data from polkesjati Covid-19 handling task force. Data were derived from a total of 1,062 respondents of RDT Antibody test and a total of 2,014 respondents undergone an Antigen swab test at age of 16 – 62 from January 2021 – January 2022. The respondents were a student from MLT, Physiotherapy, Midwifery, and Nursing students and employees. RDT Antibody test showed that reactive case was high in February and June 2021, meanwhile, Antigen swab test showed an increasing result from February to April 2021 and gradually decreased in September 2021. The most interesting part was shown from a contact tracing that indicated 7 respondents with a positive antigen test. The lowest portion of antibody and antigen detection indicated the successful strategy of task force especially with suspect cases.

Gallbladder carcinoma is an aggressively malignant disease carrying an extremely poor prognosis. Undifferentiated spindle cell carcinoma, the rarest of all gallbladder cancers also has the same prognosis. Patients usually have no specific or vague presenting symptoms, thus, in such scenario presentation with late-stage disease is often common. We herein have reported a case of 63-year-old male who presented with short history of abdominal pain and fever. Our case was different as his radiologic investigations were suggestive of cholecystitis with cholelithiasis for which cholecystectomy was done but it was later diagnosed to be a case of SpCC.