The diabetic patients knowledge of his pathology is integral to his care, and his training in this area has become a public health priority.

Introduction: The city of Jayapura which has been affected by the Covid 19 pandemic, does not have a plenary accredited PHCs, so blended learning assistance is needed. The readiness of QI in PHCs which is influenced by 3 maturity domains requires a learning strategy. Aims to analyze the renewal of learning strategies in accordance with the QI readiness of the PHCs so that it can improve the quality of the PHCs continuously towards plenary accreditation.

Introduction Frequently monitored, occurrences of peptic perforation due to a variety of etiologies are still frequently discovered. The surgical Graham Patch Repair technique is still regarded as having a respectable level of accuracy and profitability.

Ovarian dermoidal cysts are benign lesions arising from germ cells. If they are large, they can pose a problem of differential diagnosis with the hydatid cyst. Transformation to a malignancy is possible. Complications are numerous, going as far as peritonitis or even fistulization in a hollow organ. We present a case of dermoid cyst of the ovary in a 33-year-old parturient with twice scarred uterus who was treated surgically and whose postoperative evolution was good.

Cranio-encephalic trauma represents a 30-millisecond event, the leading cause of death or severe disability in young adults. It is therefore necessary to determine the nature and extent of the lesions as quickly as possible because the situation can deteriorate very quickly in the following days. Overall mortality remains heavy and sequelae frequent, which poses the problem of socio-professional and family reintegration. At the end of this study, we arrived at the following results: The prevalence of patients with cranio-encephalic trauma admitted to the General Hospital of INERA YANGAMBI was 44.5% during the period of our study; Most of our patients were male with 68.4%; The 20 to 29 age group was more affected; The students were more victims of cranio-encephalic trauma ; Road traffic accidents are the main etiology of cranio-encephalic trauma with 4% of cases in our research environment; The abrasion was the most observed anatomo-pathological lesion with 3% ; The majority of our patients had a clear conscience on admission with 72.5%; the evolution of the majority of patients was marked by an improvement with 2%

Convalescent plasma is plasma that is already present in the body and includes anti-SARS-CoV-2 antibodies. This plasma includes antibodies that may kill viral particles, thereby preventing virus entrance into cells. This neutralizing procedure has an effect on the improvement of a patients clinical state after receiving convalescent plasma treatment. The possibility of this convalescent plasma therapy as a treatment for individuals infected with SARS-CoV-2 has been evaluated, and clinical trials are still ongoing. The aim of this study is to determine the antibody titer of the donor. The research was a descriptive study. Total sample was 25 repeated male donors. The data of their IgM and IgG levels was obtained from Management Information System at Red Cross Indonesia Of Tulungagung Regency. Data was presented as table. The mean IgG level of repeated convalescent plasma donors is higher than the mean IgM level. The mean IgM level of repeated convalescent plasma donors is often constant. The mean IgG level of convalescent plasma donors increased through the fifth donor and then declined from the sixth to the ninth donor. The mean result of IgM and IgG has decreased by a higher proportion than it has increased.

Wilsons disease (WD) is a copper metabolism disorder that is inherited in an autosomal recessive manner, which produces a toxic accumulation of copper mainly in the liver and brain, in general it has two forms of presentation, hepatic which is it is more prevalent at early ages and the neurological one that occurs at later ages. Although WD is not a common disease, it should be suspected in all chronic liver disease of undetermined etiology with negative viral markers and autoimmunity, either with or without neurological manifestations, as soon as possible and thus start treatment with copper chelators, which mainly leads to to a substantial improvement in the prognosis of these patients.

Abdominal traumatism (AT) produces lesions in the wall or in the content (viscera, mesos, vascular ducts, biliopancreatic, urinary tract). The abdomen can be injured in isolation, although about a third of pediatric polytraumatisms are associated with AT. AT implies a high vital risk due to two circumstances: hemorrhage due to injury to solid organs or blood vessels and peritonitis due to perforation of hollow viscera. The global mortality varies between 5 and 15% and reaches 50% in the lesion of the great vessels. Management of these injuries is key to patient survival.

Background: The International Academy of Cytology (IAC) has established standardizedapproach for reporting breast FNAC by categorizing lesions in a five-tier system from C1 to C5. Materials and Methods: From May 2020 to April 2021, a descriptive cross-sectional study was conducted in the cytology section of the Department of Pathology, SMS Medical College, Jaipur. Results: The current study involved 335 cases of breast FNAC, with a maximum of 333 (99.40%) females and 2 (0.60%) males. Maximum cases were in the age range of 21-40 years. There were 79 (23.60%) cases in C1 (Insufficient) category, C2 (Benign) had 177 (52.80%) cases, C3 (Atypical) had 9 (2.70%) cases, C4 (Suspicious) had 16 (4.80%) cases, and C5 (Malignant) had 54 (16.10%) cases respectively. Fibroadenoma was the most prevalent benign lesion in our analysis, accounting for 45 of the 177 benign cases, whereas ductal carcinoma was the most common malignant lesion.In a total of 92 cases where histology was examined, 86 cases were found to be compatible with the cytological diagnosis. In a triple assessment, 103 (78.03%) of the 132 cases were concordant in the benign group, only 1 (12.50%) case showed concordance in the atypia category, and 21 (39.62%) of the 53 cases showed concordance in the suspicious or malignant category. The Risk Of Malignancy (ROM) was calculated as follows: inadequate 0%, benign 0%, atypia 0%, suspicious for malignancy 71.43%, and malignant 97.56% for each group. Conclusion: This system is a valuable tool for breast cancer patient diagnosis and care. It also simplifies clinical audits and aids in improved coordination between pathologists, hospitals, and institutes.

Background: The virtue of QUID is that there are only six short questions, they are all consistent in length, and their values adjust when symptoms become better. Urinary incontinence examinations can be carried out in a variety of ways to make a more thorough diagnosis, including history taking, directed physical examinations, urinalysis and residual volume, post-urine. voiding, and special examinations. Using a urinary incontinence diagnosis questionnaire, it is ideal to be able to identify the type and level of urinary incontinence that occurs. Numerous languages, including Indonesian, have had their translations of QUID put to the test. Methods: Utilizing a QUID device that has undergone validity and reliability testing, the study was carried out using a cross-sectional observational survey method to determine the prevalence rate of urinary incontinence. It then moved on to an internal comparative analysis to determine the relationship between risk factors and the incidence of urinary incontinence. Results: Urinary incontinence was a complaint made by 40 persons (10%). Only age remained as a variable that only influences the probability of urine incontinence after performing a multivariate analysis using the logistic regression method. Age 51 to 60 is anticipated to have a 4.280 times higher risk of urinary incontinence than age 18 to 50, which is statistically significant (p=0.002). In the meantime, those over 60 were statistically significant (p=0.000) and at risk up to 21.4 times more than those between age18 and 50. Conclusions: Both medical and paramedical staff can use the QUID questionnaire and recommend it for wider usage, particularly in primary care or level I health institutions for screening, as this treatment can still be started in early.

Glaucoma is the leading cause of irreversible blindness worldwide and it is important to assess the impact of timely diagnosis and treatment on this disease due to the complications it can bring to patients. It is an insidious pathology and sometimes it is usually detected spontaneously in ordinary consultations. The most frequent type of glaucoma is primary open-angle glaucoma (POAG), being the second cause of blindness worldwide according to the WHO. Making known and providing information on the subject can reduce cases of blindness in the world and patients could lead a better quality of life by going to the doctor in time knowing how to identify the pathology through its clinical picture in early stages. Glaucoma is the leading cause of irreversible blindness worldwide. It is an insidious pathology that is usually detected spontaneously. The most common type is the open angle primary (OPAG). It is important to know and provide information in order to detect and prevent cases of blindness in the world.

Background: Smoking increases the risk of CVD, however, the magnitude of this increase in risk varies substantively according to a range of factors. Smoking-related CVD risks are highest in current and recent smokers, compared to never smokers and those who have quit in the more distant past. Risk also increases with increasing duration of use and with greater intensity of smoking, as measured by the number of cigarettes smoked per day. Methods: In the present study, a total of 60 male smokers having a history of smoking of more than 2 years and smoking at least 3 cigarettes per day were included in the study, provided they met the inclusion and exclusion criteria. 60 healthy male patients were included as controls/non-smokers. Demographic details were noted. Past, present and other relevant histories were recorded. Physical examination was done. Standard 12 lead ECG was done in the resting state after 2 hours of abstinence from strenuous physical activity, smoking and/or any caffeinated beverages. Results: In the present study, it was observed that the mean age of the non-smokers was lower (27.85 ± 5.11 years) than that of smokers (30.22 ± 5.26 years); P value: 0.014. Only males were included in the present study. The BMI and heart rate were similar in the smokers and non-smokers; P value: more than 0.05. The majority of the cases had normal axis on ECG in both the groups (86.66% in non-smokers and 70% in smokers). Left axis deviation was more common than the right axis deviation in both the groups. The difference between the two groups was statistically insignificant; P value: 0.063. The width and height of the P wave were similar in both the groups; P value: more than 0.05. The R wave was significantly bigger in the smokers (12.53 ± 4.63 mm) than in the non- smokers (10.05 ± 2.93 mm); P value: 0.001. The duration of PR interval was significantly more in the smokers (140.10 ± 18.37 ms) as compared to non-smokers (129.45 ± 19.90 ms); P value: 0.003. T wave inversion was present in 10% cases of smokers while no case in the non-smoker group had T wave inversion; P value: 0.027. The ST segment was normal in most of the cases (98.33% in the non-smokers and 96.66% in the smokers’ groups); P value: more than 0.05. All the cases in both the groups had normal sinus rhythm with normal PR interval, no tall T wave, no wide QRS interval or shortened QT interval. Conclusion: The study concluded that the smokers have a mean age of 30.22 ± 5.26 years. The heart rate is similar to non-smokers. In general, normal axis on ECG is more common. Left axis deviation is more prevalent than right axis deviation. Smokers have bigger R waves, increased PR duration and inverted T waves. This may be because smoking generally causes a transient increase in heart rate and ECG changes, especially those pertaining to ST-T segment.

Polymorphic Light Eruption (PLE) is a dermatosis related to ultraviolet radiation (UV), which is why it occurs mainly in anatomical sites exposed to the sun. It can vary in morphology from one subject to another, however, in the same patient it is usually monomorphic and the most common form of presentation is the papular variant. There is a higher prevalence of this disorder in fair-skinned people and in women, while climate and latitude are also contributing factors. Its relationship with systemic lupus erythematosus is not very clear, but its histopathology and symptoms may be the key to understanding this phenomenon.

Background: Smoking increases the risk of CVD, however, the magnitude of this increase in risk varies substantively according to a range of factors. Smoking-related CVD risks are highest in current and recent smokers, compared to never smokers and those who have quit in the more distant past. Risk also increases with increasing duration of use and with greater intensity of smoking, as measured by the number of cigarettes smoked per day. Methods: In the present study, a total of 60 male smokers having a history of smoking of more than 2 years and smoking at least 3 cigarettes per day were included in the study, provided they met the inclusion and exclusion criteria. 60 healthy male patients were included as controls/non-smokers. Demographic details were noted. Past, present and other relevant histories were recorded. Physical examination was done. Standard 12 lead ECG was done in the resting state after 2 hours of abstinence from strenuous physical activity, smoking and/or any caffeinated beverages. Results: In the present study, it was observed that the mean age of the non-smokers was lower (27.85 ± 5.11 years) than that of smokers (30.22 ± 5.26 years); P value: 0.014. Only males were included in the present study. The BMI and heart rate were similar in the smokers and non-smokers; P value: more than 0.05. The majority of the cases had normal axis on ECG in both the groups (86.66% in non-smokers and 70% in smokers). Left axis deviation was more common than the right axis deviation in both the groups. The difference between the two groups was statistically insignificant; P value: 0.063. The width and height of the P wave were similar in both the groups; P value: more than 0.05. The R wave was significantly bigger in the smokers (12.53 ± 4.63 mm) than in the non- smokers (10.05 ± 2.93 mm); P value: 0.001. The duration of PR interval was significantly more in the smokers (140.10 ± 18.37 ms) as compared to non-smokers (129.45 ± 19.90 ms); P value: 0.003. T wave inversion was present in 10% cases of smokers while no case in the non-smoker group had T wave inversion; P value: 0.027. The ST segment was normal in most of the cases (98.33% in the non-smokers and 96.66% in the smokers’ groups); P value: more than 0.05. All the cases in both the groups had normal sinus rhythm with normal PR interval, no tall T wave, no wide QRS interval or shortened QT interval. Conclusion: The study concluded that the smokers have a mean age of 30.22 ± 5.26 years. The heart rate is similar to non-smokers. In general, normal axis on ECG is more common. Left axis deviation is more prevalent than right axis deviation. Smokers have bigger R waves, increased PR duration and inverted T waves. This may be because smoking generally causes a transient increase in heart rate and ECG changes, especially those pertaining to ST-T segment.

Idiopathic solar dermatoses represent a group of diseases in which a chromophore endogenous is modified by the action of ultraviolet radiation and triggers clinical pictures characteristic. The most common of these entities is the polymorphic solar eruption, which represents one third of all photodermatosis. The study of idiopathic solar dermatoses is important, since they are frequent entities, have a negative in the quality of life of the patient and show characteristics similar to other skin diseases. An adequate diagnosis is crucial to determine the therapeutic approach, although on some occasions it may have spontaneous resolution. Photodermatoses are skin diseases produced by the action of electromagnetic radiation on the skin, either in the ultraviolet spectrum or in the range of visible light. A guest is required for your presentation immunologically susceptible.

Background: Glaucoma is the second most common cause of blindness and the leading cause of irreversible blindness worldwide. It is a chronic optic neuropathy with characteristic optic disc changes and corresponding visual field defect. Aim: The aim of this study was to determine the clinical profile and intraocular pressure control of Primary Open Angle Glaucoma (POAG) patients on medical treatment at the glaucoma clinic of Enugu State University of Science and Technology Teaching Hospital Parklane (ESUTTHP), Enugu with a view for better patient management.

Introduction: The quality of the results of education and training of health workers in general is still inadequate. Ineffective training activities can be seen in the number of complaints from trainees and learning outcomes that are not optimal. The aimed to find out the influence of Experimental Strategy-based training on the Coordination of Health Training Participants. Materials/Methods: This study used qualitative methods. The informants were 12 trainees. Data collection used in-depth interviews. The tools used were tape recorders, and camcorders. Results: his study found that the Experiential Learning method is relevant for use in increasing Competency Based Training in a group of health workers (Doctors, Nurses, Midwives, and SKM (Bachelor of Public Health) who come from different functional health positions) at the South Sulawesi Community Health Center. Conclusion: Competency Based Training for health workers can be done using one method, namely Experimental Learning.

Introduction: Achalasia occurs in up to 10 out of every 100,000 people worldwide, is associated with a large number of symptoms that can impact the patients quality of life laparoscopic myotomy of Héller with fundoplication represents the gold standard surgery in the treatment of this condition, has shown symptomatic improvement of the patient, However, studies have reported that there are no significant manometric and symptomatic changes in postoperative follow-up, and little has been reported in the literature, particularly in our population.

Mastocytosis is one of eight subcategories of neoplasms. Classification of Myeloproliferative Tumors of Lymphoid Tissues and hematopoietics of 2008 of the World Health Organization; is a heterogeneous group of myeloproliferative diseases that distinguished by excessive proliferation of mast cells morphologically and immunophenotypically atypical, in addition to the accumulation of these cells in one or more organs or tissues, including the skin, bone marrow bone, liver, spleen, and lymph nodes

Adverse drug reactions are quite frequent in current medical practice, being the skin manifestations the most commonly observed, and although they generally have a benign and self-limiting evolution, but in exceptional cases they can be serious and even fatal. The priority in the evaluation of toxicoderma is established in the identification and distinction of severe skin adverse reactions, the so-called SCAR, among which include Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome/drug reaction with the presence of eosinophilia and systemic symptoms (DISH-DRESS), to which should be added acute generalized exanthematous pustulosis (AGEP). Unfortunately, however, our current knowledge does not allow us to determine the true incidence of these reactions, to establish the diagnosis and its causal relationship with certainty, or even to be able to anticipate its appearance.

Introduction: A granulomatous lymphadenitis is a form of inflammation of the lymph nodes that are often found. Until now, effective treatment of granulomatous lymphadenitis is still inconsistent, namely between surgical intervention, antibiotics, or adjuvant therapy. Objective: This study aims to determine the response to adjuvant therapy in patients with granulomatous lymphadenitis at RSUD Prof. Dr. Margono Soekarjo in 2019 – 2020. Methods: The research was a descriptive observational study with a retrospective approach that used secondary data from the medical records of the polyclinic and inpatient ward of RSUD Prof. Dr. Margono Soekarjo Purwokerto. Results: A total of 5 patients with tuberculous granulomatous lymphadenitis (66,7%) experienced a complete response to therapy after surgical excision followed by administration of anti-tuberculosis adjuvants an average of 6,5 ± 3,6 times and a mean duration of administration of 22,5 ± 14,7 weeks. A total of 14 patients with non-tuberculous granulomatous lymphadenitis (73,7%) experienced a complete response to therapy after surgical excision, incision drainage followed by adjuvant antibiotic therapy alone or in combination with 1-3 times and the median duration of administration was 3,5 weeks. Conclusion: Surgical excision followed by adjuvant therapy in tuberculous and non-tuberculous granulomatous lymphadenitis has good cure rates.

As many as 37% of all cases of head injuries are cases of eye injuries. 1790 cases of eye injury were experienced by welders, solderers, and metal cutters, and around 1390 cases of eye injury were caused by exposure to welding sparks. Informal sector welding workers have a high risk of photokeratitis. In the informal welding industry along Jalan Bogor, Bandung City, there is an extreme level of risk. One of the extreme risks is photokeratitis caused by the welding process (UV exposure). This study uses a quantitative approach, with this type of observational research. The population in this study were workers in the informal welding sector in Jalan Bogor, Bandung City. The sample size is 60 workers obtained through the purposive sampling technique. The variable in this study was the complaint of photokeratitis. Data collection used a questionnaire with 7 questions about photokeratitis complaints. Descriptive analysis was used in this study, the data is presented in tabular form which can explain the distribution of photokeratitis complaints and the distribution of photokeratitis categories among workers. The results of this study can be concluded that the most dominant photokeratitis complaint experienced by workers is visual disturbances such as blurred vision or unclear vision with the number of workers experiencing symptoms as much as 34 or 56%. The least common symptom experienced by workers is that their eyes water a lot, only 9 workers or 15%. In the results of categorizing photokeratitis complaints, there were 60% of workers had photokeratitis complaints. Employers need to pay full attention to this case, one thing that can be done is to provide Eye Protection Equipment and adjustments to working time or duration of exposure.

Urogenitalia in woman prevalance in Indonesia is poorly reported and published. Information regarding this distribution of urogenitalia cases in woman may be beneficial to improve our management strategies and help the government to develop better healthcare policy in the city. We collected medical records from multiple hospital in Makassar from 2019 to 2020 that diagnosed with urogenitalia diseases. We found 472 patiens that diagnosed from Urogenitalia diseases from 2019 to 2020. Pelvical organ prolapse is the most frequent case accounted for 59.5% of study population followed by rupture of perineum and urinary tract fistula, 10.8% and 7.4% respectively. Others case were accounted below 3% with 19 total diagnosis. Conclusions: Both medical and paramedical staff can use the QUID questionnaire and recommend it for wider usage, particularly in primary care or level I health institutions for screening, as this treatment can still be started in early.

Pemphigus vulgaris is the most common variant of autoimmune chronic blistering skin diseases. Its appearance in patients infected with acquired immunodeficiency virus (HIV) is rare. A 40-year-old woman is reported, who presented skin lesions in 90% of the body surface, characterized by blisters of 3 to 4 cm that, when broken, left denuded areas, excoriations and pruritic meliceric crusts. A skin biopsy was performed that showed a characteristic pattern of pemphigus vulgaris. Elisa for HIV positive. She evolved with septic shock and died 72 hours later. Understanding the relationship between HIV and autoimmune blistering disorders can help guide the therapeutic and prognostic management of these patients. Proposed mechanisms include molecular mimicry, polyclonal B-cell stimulation, and highly active antiretroviral therapy possibly associated with immune restoration. Clinically, these patients may present limited mucosal symptoms or develop multiple erosions that may spread, merge, and progress to exfoliative erythroderma. Glucocorticoids serve as the first line of management; however, they can have important adverse effects such as infectious complications that pose a therapeutic challenge for the doctor and could influence mortality.

Pulmonary venous aneurysm often presents as a mediastinal mass, in most cases patients are asymptomatic and surgical treatment is not required unless there are complications. We present the case of a 34-year-old woman, with a normal evolutionary pregnancy of 36 weeks of gestation, with dyspnea on small to medium efforts, to which was added pleuritic pain in the left hemithorax, evidence of left pleural effusion greater than 80%, with drainage of 700 ml of hematic fluid. The gynecology and obstetrics service identified anhydramnios, deciding to terminate the pregnancy through the abdomen. A simple and contrast- enhanced chest tomography was performed, as well as papanicolaou staining of pleural fluid with a negative report for malignancy. The angiotomography reported an aneurysm of the left lobar vein with a fistulous tract, so cardiothoracic surgery performed resection of the saccular aneurysm by thoracotomy without complications. Pulmonary vein aneurysms are such rare lesions that there are no data in the literature to predict their natural history or pathogenesis. During pregnancy, cardiovascular causes of mortality predominate; on this spectrum, hemothorax could be a true surgical emergency.

Tungiasis is a cutaneous ectoparasitosis caused by the flea parasite Tunga penetrans, prevalent in South America, the Caribbean, and sub-Saharan Africa. Clinically it is characterized by the formation of single or multiple papules with a translucent whitish halo and a brownish-black central region, frequently located on the feet. The lesions may present with itching or mild pain, with bacterial superinfection being the most frequent complication. The diagnosis was made based on the clinical characteristics of the lesions in a patient from endemic areas. The treatment of choice is surgical removal of the flea followed using topical antimicrobials and tetanus vaccination. Prevention is essential with the use of closed footwear and repellents.

Introduction: Achalasia occurs in up to 10 out of every 100,000 people worldwide, is associated with a large number of symptoms that can impact the patients quality of life laparoscopic myotomy of Héller with fundoplication represents the gold standard surgery in the treatment of this condition, has shown symptomatic improvement of the patient, However, studies have reported that there are no significant manometric and symptomatic changes in postoperative follow-up, and little has been reported in the literature, particularly in our population.

Background Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection because they have low innate immunity as well as poor antibody response to COVID-19 vaccine. This study aimed to assess the effectiveness of 4 doses of COVID-19 vaccine in preventing 5th wave of COVID-19 infections in patients on maintenance hemodialysis in Myanmar.

Bilateral tubectomy is one of commonly used method of contraception worldwide as a permanent method of family planning procedure for women, which can be done laparoscopically or by open method of surgery. Many women regret for their decision of permanent sterilization and some of them come to restore their fertility, because they have lost their press child which is usually male and some come because they have remarried. To restore fertility in post tubectomy women, fallopian tube re-canalization or in vitro fertilization (IVF) is the answer. For post-tubectomy cases, fallopian tube recanalization can be done manually by open surgery or with laparoscope. Since 2014 till date, 18 cases of post-tubectomy fallopian tube recanalization, manually by open method of surgery is done. This method was found to be most feasible, simple and no special instrument or equipment was needed. As such general surgical instruments were used in bilateral fallopian tube anastomosis with too satisfying results.

Zollinger-Ellison Syndrome is a rare disease caused by tumors called "Gastrinomas", causing high levels of gastrin that produces acid hypersecretion and even gastric ulcers. We present a 20-year-old patient with a 2-month history of pain in the epigastrium accompanied by nausea, vomiting, and weight loss with a history of upper gastrointestinal bleeding from a duodenal ulcer, which on physical examination revealed a tumor in the epigastrium. Contrast-enhanced abdominal CT showed a tumor mass in the tail of the pancreas. She underwent surgery, performing a corporocaudal pancreatectomy and splenectomy, with favorable post-surgical evolution. The anatomopathological study reports pancreatic gastrinoma.

During the pandemic, the management of corpses for Covid-19 was carried out according to the protocol by WHO. In practice, there are several difficulties in the field, one of which is if there is a sudden death where the death is not in a health facility, tools are needed to assess whether the death is related to Covid-19. This is important to decide whether the bodies are treated like Covid-19 or not. The Ministry of Health of the Republic of Indonesia has made verbal autopsies of deaths that should be suspected of being related to Covid-19. This study aims to evaluate the performance of this verbal autopsy against diagnosis in medical records. As many as 97 families of patients who died in the inpatient room were interviewed using a verbal autopsy, then the doctor concluded whether the death was related to Covid-19 or not without previously knowing the patient s diagnosis. After that, the patient s medical record is seen to find a diagnosis during treatment. Then the results were compared with the conclusions using a verbal autopsy. In this study, the autopsy verbal sensitivity was 88.09%, the specificity was 88.09% and the area under the curve was 76%, which means that the autopsys verbal ability in diagnosing Covid-19 related deaths is considered good.

Background: Adolescence is a critical and formative period in which individuals begin their transition from childhood to adulthood and the presence of psychiatric disorders such as depression and anxiety at this stage of life is a matter of concern. Half of all mental health conditions start at 14 years of age but most cases are undetected and untreated. Objectives: To assess the prevalence of depression and anxiety among adolescents and to assess the factors associated with depression and anxiety among adolescents. Methods: Data were collected from a sample of 620 adolescents of ages 14 to 16 years studying through the multistage cluster sampling method. Depression, Anxiety and Stress Scale-21, a pre-tested questionnaire for sociodemographic details were used. Statistical analysis was done using SPSS 20 version. Pearson’s chi-square test and logistic regression were applied to find the association between categorical variables where appropriate. Conclusion: Out of 620 adolescents, 64.5% were female and 35.5% were male, 41.3% of the study population were 14 years old, 43.1% of 15 years old and 15.6% were 16 years old respectively. Prevalence of depression and anxiety among adolescents were found to be 50.32% and 62.74% respectively. Depression and play hours outside the house were significantly associated; anxiety and age, duration in present school, number of people at home, working people in the family were found to be statistically associated.

Background: health informatics have bene used in the field healthcare for quite a long time. Research investigations have since been conducted to examine various features around the use and application of health informatics. However, there is an apparent gap in the current literature in regard to comprehensive information about the effect of health informatics on the healthcare workers’ practices in Saudi German Hospital, Jeddah. Aim: the aim of this research was to evaluate the implication of health informatics on the healthcare workers’ activities in Saudi German Hospital in Jeddah, Saudi Arabia. Methods: this study applied cross-sectional quantitative research design. Upon seeking and receiving the ethical approval, a sample of 123 sample of healthcare workers in Saudi German Hospital, Jeddah were recruited for data collection. Henceforth, data was collected using survey questionnaires, to which 105 (85.3%) responses were received. The collected data was then analyzed using three statistical tools of SPSS, including the descriptive statistics, Spearman’s rank correlation coefficient, multiple linear regression and multiple analysis of variance. Results: this study found out that health informatics has two critical roles regarding the healthcare workers practices. This was indicated by 40.9% of the participants who strongly agreed that health informatics augments quality of healthcare services delivery and 41.9% of the participants who strongly agreed that health informatics enhances information quality. This study further established that health informatics has a statistically significant impact on the quality of patient care (r=502; p=.000), health workers competencies (r=522; p=.000), and patient safety (r=457; p=.000). Further, this research also observed that the perceived roles of health informatics was had statistically significant association with the healthcare workers’ age (p=.023) and education level (p=.033). Recommendation: there is a need for the healthcare administrations units to intensify the use of health informatics to improve the quality of healthcare service delivery as a function of the healthcare workers.

Background: Gestational trophoblastic disease is caused by placenta abnormalities and can metastasize in several places outside the uterus, including the vagina. Its criteria are based on physical examination, laboratory examination, ultrasonography, and histopathology. In addition, the malignancy classification is based on FIGO 2000. Treatment is then carried out according to the malignancy level, and monitoring of results can be carried out based on the ß-hCG measurement. Case illustration: A 38-year-old multiparous patient with a gestational age of 12 weeks based on HPHT experienced bleeding in the last three hours before admission to the hospital, originating from a 4 x 4 cm vaginal mass detected in the lower 1/3 of the vagina and active bleeding. Ultrasound examination of the whole abdomen showed that the uterus was enlarged and anteflexed with a uterine size of 18x20 cm according to the gestational age of 20 weeks; a multilocular cystic mass appeared in the adnexa area with the impression of a lutein cyst measuring 3x3 cm; a heterogeneous mass appeared in the uterine cavity with multiple anechoic areas giving a Honeycomb appearance; no gestational sac was seen, and the myometrium was intact. Also, the examination of ß-HCG levels was found to be more than 1,000,000 mIU/mL. Based on the presence of a vaginal mass suspected of being metastatic from the uterus, a WHO scoring was performed, and a score of 7 was obtained so that it was included in the high-risk category. Conclusion: Diagnosis and classification of gestational trophoblastic disease help determine appropriate management, thereby increasing patient treatment success.

Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z = -2.353, p = 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z = -3.186, p = 0.001]. Lactate clearance over time was well observed in the intervention group, [X2 (2) = 29.356, p < 0.001] but not in the control group, [X2 (2) = 3.152, p = 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X2 (3) = 39.330, p < 0.001]. All-cause mortality within 7 days was not different, [X2 (1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51 – 7.12)]. Conclusion: Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.

surgeries and can have an important impact on the postsurgical evolution of the patient with bile duct pathology, in many cases it may represent greater severity than the primary condition reason for the surgical procedure; Hepaticojejunanastomosis is the surgery of choice however studies establish a limited half-life with high probability of reoperation. Objective: To estimate the half-life of hepatitcoyunoanastomosis first performed in the UMAE 25 of the IMSS in patients with bile duct lesions. Conclusions: The design of strategies in the repair of the bile duct requires institutional support according to the conditions of patients suffering from bile duct conditions, where the prevention of these conditions is based on an adequate mastery of biliary anatomy by the surgical team, as well as a good surgical technique, with the firm decision to convert to open surgery when laparoscopic surgery is not possible to identify the anatomical structures or failing that, the immediate transfer to a specialized center if required, positively influencing the evolution of the patient, reducing complications and ultimately mortality.

Chronic kidney disease (CKD) is a disease whose incidence and prevalence have increased globally, this pathology is associated with multiple morbimortalities, especially in the cardiovascular field (Ewen et al.,2019). This risk rises much more if the disease reaches terminal level with the need for the use of hemodialysis, reaching more than half of these patients with cardiac comorbidities. These cardiovascular complications are extensive, notably coronary heart disease, arrhythmias and valvular diseases that eventually lead to death. We will focus on the latter. In earlier stages, heart valves show calcification and, consequently, stenosis. It is for this reason that, according to Ewen et al. the prognosis of CKD depends on the vitality of the heart valves. Thus, in a patient with end-stage CKD, progression to significant valve destruction occurs 10 times faster than in a person with healthy kidneys. It is for these reasons that the evaluation of valvular disease, especially of the aortic valve, is of utmost importance.

Summary: Burns are skin damage caused by heat trauma or cold trauma (frost bite). Causes include fire, hot water, electricity, chemicals, radiation, and cold (frostbite). This damage may involve subcutaneous tissue. Burn injuries are associated with high incidence and prevalence, high risk of morbidity and mortality, resource-intensive, and costly. One of the most common complications in burn patients is acute kidney injury (AKI). The mechanism of early AKI after burn injury is multifactorial, and previous studies have mainly focused on oxidative stress injury, tubular apoptosis, and systemic or local inflammation. Previous results (from our group and others) suggested that ROS-induced oxidative stress damage and apoptosis play an important role in the development of early AKI due to burn injury, and that 24 h after burn injury are useful for observing changes in burn injury. It shows that it provides an important timeframe. Kidney function and levels of oxidative stress and apoptosis. Astaxanthin (ATX) is a naturally occurring carotenoid that is readily obtained from marine organisms and stronger antioxidant effects than other carotenoids. Given the critical role of oxidative stress and secondary renal inflammation in severe burn-induced early AKI, a protective role of ATX through its anti-inflammatory effects and potential mechanisms of action in early post-burn AKI is reasonable.

Introduction: The mediopatellar plica are folds in the synovium that represent the embryological remnant in the development of the synovial cavity of the knee. Our study aim to investigate the damage to the mediopatellar plica using the Sakakibara classification and cartilage lesions using the Outerbridge classification based on the arthroscopy findings of the knee. Methods: A multi-center retrospective cross-sectional analytical study was conducted on patients at Wahidin Sudirohusodo Hospital and network teaching hospitals in Makassar, South Sulawesi Indonesia, the study was conducted in January – March 2021. The results of assessment the damage to mediopatellar plica using the Sakakibara classification and Cartilage lesions use the outer bridge classification. After that, data was processed to analyze the correlation between damage to the mediopatellar plica and cartilage lesions as well as related variables. Results: In the early study, 119 patients were included, where the final follow-up was obtained for 91 patients (76.5%). The existence of a positive correlation between damage to the mediopatellar plica based on the Sakakibara Classification and cartilage lesions based on the Outerbridge Classification, where the greater the damage to the mediopatellar plica based on the Sakakibara Classification, the higher the cartilage lesions based on the Outerbridge Classification. Conclusions: There is a relationship between the characteristics of the sample and plica damage based on the Sakakibara classification, meanwhile, the plica damage based on the Sakakibara classification shows the opposite result. There is a corelation between plica damage based on the Sakakibara classification and Cartilage lesions based on the Outerbridge classification.

Gunja (Abrus precatorius Linn.), also known as Indian liquorice, is regarded as one of the most toxic but also visually stunning seeds in the world. It is classified as an Upavisha (semipoisonous medication) and is utilised widely in several Ayurvedic formulations with significant medicinal value. According to Ayurveda, Gunja should only be administered after appropriate Shodhana (purification techniques) using various media, including Godugdha (cows milk), Kanji (sour gruel), etc. Common names for Abrus precatorius Linn. include Gunja and Jequirity, and it is widely distributed throughout Indias plains. It is classified as an Upavisha (semi-poisonous medications) and is widely utilised in several Ayurvedic formulations with significant therapeutic value. It has been noted that Gunjas seed, root, fruit, and leaves are used as an ingredient in many formulations. Netra roga (Eye Diseases), Khalitya (Alopecia), Sarpa Visha (Snake Poison), Jwar (Fever), Indralupta (Alopecia),Keshya (Hair Tonic), Prameha (Urinary Disorder), etc. are some of the diseases.Different dosage forms are used to administer different parts of the Gunja plant, including swarasa (juice), kwatha (decoction), lepa (paste), anjan (application in the eye), avaleha (semi-solid preparations), taila (oil), rasa (mineral preparation), vati (pills), modaka (solid dosage form)ghrita (fat soluble preparations) & churna (powder).

Network pharmacology is expanding as a comprehensive paradigm and becoming a breakthrough research topic of pharmaceutical research by providing an extraordinary potential for the comprehensive examination of conventional treatments. The development of network pharmacology has paved the way for the implementation of the complex phytochemical constituents found in diverse natural products. Network pharmacology is a burgeoning field of study that has linked its legs not just to Traditional Chinese Medicine, but also to other natural products, herbs, and ayurvedic medicine. By being a multidisciplinary area that includes network biology, system pharmacology, and even omics, it has demonstrated its unimaginable potential for future research. It is, in particular, a network-based science. Natural products have long served an important role in the advancement of pharmaceutical research, with all the supplementary immense expertise that has yet to be demonstrated, which can be established with the help of this application, which in turn may demonstrate the potential of these natural products to be multitargets, multicomponent characteristics of them rather than the solitary target that is becoming a dilemma in developing drugs. In this review paper, we summarised the notion of network pharmacology and discussed the newer features of how this concept might be used to natural products as well as drug discovery

Granulosa cell tumours are extremely rare and very few cases of adult type have been reported till date . Granulosa cell tumours can broadly classified into juvenile and adult types. They are known to occur more commonly occurs in females (in ovaries) than in males (in testis) . We here reported here a case of 39 year old man who was diagnosed with testicular adult granulose cell tumour with no metastasis . A High Inguinal radical Orchidectomy was performed with histology demonstrating no invasion of the tunica albuginea , epididymis , spermatic cord and no lymphovascular invasion . The aim of the present report is to document another case of AGCT to summarize the knowledge regarding this rare tumour.

Background: shortage of nurses is a common challenge in nursing and healthcare with a few nurses working in overtime schedules to meet patients’ demands. Therefore, the amount of time spent by nurses is of critical value to the healthcare organization as it is to patients. Improvements in healthcare technology, notably the introduction of nursing informatics, has tried to improve nursing practices with the goal of meeting efficient patient care. Consequently, researchers moved in to examine the significance of the electronic health systems, such as the electronic health records in improving efficiency of nurses’ practices, and several diverse outcomes have been reported. Objective: due to the divergent outcomes, this integrative review was designed to assess whether there were agreeing outcomes regarding the impact of health electronic system on time efficiency in nursing. Methods and results: a total of ten literature articles obtained from PubMed and Google Scholar met the quality assessments and inclusion criteria and were thus included in this review. These articles were published in the last ten years in English and used primary data. All the articles used quantitative methodologies. The analysis of the individual study findings resulted in the construction of two thematic outcomes: the changes in the documentation time and improvement in nurses’ work proficiency and clinical efficiency. Therefore, this review identified that electronic health systems had a significant effect in altering the documentation time in a nonspecific way. Also, the effect on nursing proficiency and clinical efficiency was definite. Recommendation: there is a need to examine organizational factors that could affect time efficiency among of the electronic health systems.