A 55yr old diabetic, hypertensive male with prior history of coronary stenting presented to the emergency department with complaints of abdominal pain and distension of duration 4 days. The abdomen was grossly distended with diffuse tenderness and guarding The Patient was evaluated resuscitated, investigated, and found to be Hollow viscous perforation with peritonitis. The Patient was subjected to emergency laparotomy. The surprise finding in the Operating room was mass arising from jejunum with perforation. The Resected specimen histopathology revealed GIST jejunum which was an unusual cause of acute abdomen.

Cranial capacity is indicative of brain volume and is important for deciding racial and sexual characteristics in physical anthropological studies. It is measured both directly by filling the cranial cavity with various materials like lead shots, mustard, cast materials etc and indirectly by using derivation formulae. In the present study, volume of the cranial cavity is measured by using mustard seeds and calibrated glass cylinder. The range of cranial capacity is 1120- 1650 cc and 800-1280 cc in male and female skulls respectively. Cranial Capacity was statistically significant, t (258) = -16.94, p = <.001, 95% confidence interval [-203.13, 160.6] it is an important measured parameter to differentiate male and female skulls. The results are useful for anatomists, medicolegal experts and anthropologists.

Background: The Health Gym Program (HGP) is the main program to promote health and physical activity in the public health system in Brazil. This intervention uses financial resources from the federal government and municipalities to encourage the population of Brazilian municipalities to adopt more active and healthy lifestyles. Objective: To evaluate the impact of the Health Gym Program on hospital admissions for type II diabetes mellitus in the state of Pernambuco – Brazil. Method: This is an impact assessment of public policies that used a panel of data from all 185 municipalities in Pernambuco from 2007 to 2018. The 130 municipalities that adopted the HGP from 2011 were designated as treaties while the others 55 that did not implement the program made up the control group. The empirical strategy used an econometric modeling that uses the difference-in-differences estimator weighted by the propensity score. Results: Hospitalizations for diabetes represented, respectively, 1.47% and 1.00% of all hospitalizations performed in 2007 and 2018. The expenditure on these hospitalizations was US$ 899,687.34 in 2018 and corresponded to 0.59% of the cost of all hospitalizations. The municipalities that implemented the HGP spent an average of 19.74% less on hospitalizations for diabetes than the municipalities that did not, and this result was statistically significant at the 5% level. Conclusion: The Health Gym Program impacted in reducing the expenses with hospitalizations for diabetes when comparing the municipalities that implemented and those that did not implement this intervention.

Background: COVID -19 the corona virus disease 2019 pandemic in India made lot of changes in each individuals especially challenges to the health care workers and system in country. The personal protective equipment undoubtedly provides a shield of protection for the health care workers fighting against the disease. However there have been various problems associated with the personal protective equipment. There is need to understand the possible influence of personal protective equipment’s in health care workers leading to urinary tract infection during covid care. Aim: To find the effect of personal protective equipment leading to urinary tract infection in health care workers during covid care. Study design: Observational study.(0nline survey) Method: Sample size of 160 was taken between age group of 18 – 45 years in health care workers on the basis of inclusion and exclusion criteria. Samples collected through Google form Results: Statistical analysis of the data was done by using the software SPSS23.0 .Descriptive statistics were calculated and summarized. Which includes frequency, percentage, Mean and standard deviation. Personal protective equipment its not leading to urinary tract infection in health care workers during covid care. Conclusion: The conclusion of the survey was based on the responses, received from the HCWs through the goggle form, personal protective equipment its not leading to urinary tract infection in health care workers during covid care they able to handle or manage while wearing PPE kit during the covid duty. Based on the result of this study around 50.4% participants have the urinary urgency to remove the PPE kit. The study showed that HCWs challenged themselves with the personal protection as well as the public health. Therefore, this study could not predict the risk of urinary tract infection in health care workers while wearing PPE kit during covid care.

The aim of the present study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. Nasal obstruction is a main occurrence of breathing difficulties, with lateral wall insufficiency (LWI) playing a crucial role. A bioabsorbable nasal implant was recently introduced to treat nasal blockage and rectify lateral wall insufficiency. In this study, a systematic review and meta-analysis were conducted to investigate bioabsorbable nasal implant efficacy in treating nasal obstruction following reconstructive or rehabilitation surgery. A bioresorbable nasal implant is "Y" shaped implant which has inserted into the lateral wall of nose to provide support for unobstructed air-flow. As implant is absorbed by the body, collagen and fresh tissue will give strength after degradation of implant. The implant can be coated with any therapeutic agent to prevent post-implantation consequences i.e. inflammation or infection.

As hernia mesh implants are used to reinforce the abdominal wall, several complications can occur, such as hernia recurrence, abdominal pain, seroma formation and infection, depending on their biocompatibility. The polymer coated knitted mesh is used to repair hernias by providing a flexible scaffold. The objective of this study was to assess skin sensitisation potential of polar and non-polar extract and In Vitro degradation and In Vivo skin sensitisation pattern for polymer coated knitted mesh. The guinea pig maximization test (GPMT) is usually performed with one moderately irritant induction dose of the allergen and gives a qualitative assessment hazard identification of the allergenicity of the chemical. The apparent morphological change, weight, and strength loss rate of the mesh all showed the degrading impact. The degradation of polymer coated knitted mesh is performed to check polymer layer pattern after implantation.

Aim: The aim of the study is to evaluate prevalence of uropathogen and antibiotic susceptibility pattern in urinary tract infection in a tertiary care hospital.Method: This is a retrospective cohort study conducted over a period of 6 months in general medicine department of tertiary care hospital, Kerala. A total of 170 patients satisfying the inclusion criteria were analyzed. Case records were retrospectively reviewed for demographic data, clinical presentations, investigations, management and outcome. Data analysis were conducted using SPSS and Microsoft Excel 2010.Results: The majority of the patients causing urinary infection were females (61.2%) when compared with men (38.8%). Out of 170 patients, the age group >70 years were more prone to urinary tract infection. Of the total study group, Gram negative bacteria (97.1%) was the most prevalent organism causing urinary tract infection, among which E. coli (64.7%) predominates. E coli shows high sensitivity to amikacin. The most common antibiotic prescribed was found to be cefaperazone/sulbactam (30.6%).Conclusion: According to the study, urinary tract infections are highly prevalent in female patients >70 years of age. Regular surveillance and monitoring are extremely important to give practitioners the most recent information on the most efficient empirical treatment for urinary tract infections because antibiotic resistance among bacterial pathogens is evolving over time and space. Based on knowledge of the pattern of antibiotic susceptibility, empirical antibiotic selection should be made in the treatment of urinary tract infections.

AIM: The aim of the study is to evaluate the prevalence of types of stroke and associated risk factors. MATERIAL AND METHOD: This is a retrospective observational study conducted over a period of 6 months in a tertiary care hospital. A total of 277 patients satisfying the inclusion and exclusion criteria were analysed. Case records of patients from the MRD were retrospectively reviewed for demographic data, past medical and medication history, habits, clinical presentation, investigations, management, outcome from the year of 2017 to 2021 June. Data analysed using SPSS and Microsoft Excel 2010. RESULT The most prevalent type of stroke was found to be Ischemic stroke (IS). The highest prevalence of stroke was found in the age group above 70 years. Most contributable risk factors of stroke were found to be the patients with both hypertension and diabetes mellitus. Out of 277 patients, 223 patients had hypertension and 160 patients had hypertension either as a single risk factor or as a combination with other risk factors. Men were more prone to stroke with the risk factors of hypertension with diabetes mellitus. CONCLUSION Adults aged =70 years had a high prevalence of stroke and a high-risk stroke population, with ischemic stroke being the most common form in our study. These results indicate that individual-level and population-level treatments for these major risk factors are required to prevent stroke because hypertension and diabetes mellitus were stronger contributors to stroke. These results have the conclusion that when establishing preventative methods, these risk factors should be considered while decision making.

Introduction: The Community Health Center (Puskesmas) is a health service facility that organizes the first level of Community Health Efforts and Individual Health Efforts (UKP) by prioritizing promotive and preventive efforts and is a Regional Technical Implementation Unit (UPTD) of the District City Health Office. In carrying out its functions, the Puskesmas implements the stages of the management functions of the Puskesmas.

Ventricular septal defects in adulthood only account for 10 per cent of congenital heart defects, In patients with evidence of LV volume overload and no Pulmonary Arterial Hypertension (no non-invasive signs of Pulmonary artery pressure elevation or invasive confirmation of Pulmonary Vascular Resistance <3 Woods Units in case of such signs), VSD closure is recommended regardless of symptoms. “Maladie de Rogers” is referred to as a VSD with a small left-to-right shunt, the pulmonary vascular resistance is not significantly elevated and the left-to-right shunt is small (Qp: Qs <1.5:1), in the absence of aortic valve prolapse and regurgitation or Infective endocarditis, may be managed by observation without need for operative intervention.

Bariatric surgery is a great option not only for rapid weight loss but also as an alternative for type 2 diabetes mellitus and ravages of metabolic syndrome. The Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently showed that this surgical alternative is better than the more aggressive treatment against diabetes and the ravages of metabolic syndrome. The laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric operation. Weight loss is achieved by drastically reducing the capacity of the gastric chamber, consequently, making the patient undergoing this procedure reduce their food consumption. In addition to this, the presence of biochemical changes lead the patient to a state of significant weight loss, with ghrelin being the main hormone involvedVarious authors conclude that sleeve gastrectomy is "the holy grail of bariatric surgery", but it is not. If so, this was the only surgery performed by these surgeons, which is not the case. Its benefits on the control of obesity as well as the almost complete remission of type 2 diabetes mellitus are very clear. Its intention is a surgery without the need for anastomosis and with preservation of the digestive tract, which makes it of very low mortality as well as future complications, including the few nutritional deficiencies that patients present after the procedure. In conclusion, laparoscopic sleeve gastrectomy deserves an important place among the bariatric procedures performed.

Gynecomastia is the proper growth in size and proportion of glandular breast tissue in men. It has various etiologies. Regardless of the stimulus or etiology, whether physiological or pathological, histologically the same changes will occur. The most used categorization for patients with gynecomastia is that of Simon BE. The management of each patient must be staggered, individualized and always offering the greatest safety. The surgeon must know this pathology to know all the therapeutic targets and their arsenal for management, surgical treatment must be reserved for selected cases and is an excellent alternative.

Cholangiocarcinoma represents a diverse group of epithelial cancers united by late diagnosis and poor outcomes, includes a cluster of highly heterogeneous biliary malignant tumours that can arise at any point of the biliary tree. Global incidence is increasing. Surgical resection is the only potentially curative treatment for patients with cholangiocarcinoma. Due to the incidence of this type of cancer, as well as its associated mortality, a timely diagnosis is necessary, but even more so, to be familiar with the surgical technique, since it is the only potentially curative option for patients suffering from this pathology.

Introduction: The PublicHealth Center (Puskesmas) is a health service facility that organizes the first level of Community Health Efforts and Individual Health Efforts by prioritizing promotive and preventive efforts and is a Regional Technical Implementation Unit (UPTD) of the District/City Health Office. In carrying out its functions, the Puskesmas implements the stages of the management functions of the Puskesmas. Materials/Methods:The research was conducted using quantitative methods with a cross-sectional approach. The research population is the Head in charge of health efforts at Puskesmas throughout Bengkulu Province. The data was collected using a questionnaire and analyzed using the Multiple Linear Regression method with the help of the SPSS version 22 application. Results:The study results showed that there were directions for planning implementation, OrganizingActuating, Supervision Control, and Assessmentlinear and multiple assessments of the health center s performance achievements. Puskesmas managers should start planning from the five-year plan to the monthly activity implementation plan. The planning must be based on evidence and involve the person in charge, implementer, community, and cross-sector. Conclusion: Carry out monthly and quarterly mini-workshops effectively and efficiently. Carryout supervision in the form of supervision and control of performance achievements monthly through mini-workshops and other meetings. Conduct performance appraisals in an effort to assess achievements and identify problems and solutions for the implementation of future activities.

Urinary tract infections are caused by an erroneous placement of catheters, This is because it is considered an invasive technique of very common hospital use, which will provide a great benefit to the patient and quite useful for the doctor. The identification in the different hospital centres of the correct technique has to be achieved to achieve an effective sterile placement and obtain a benefit rather than a harm to the patient. However, the fact of having to identify the correct techniques has shown certain deficiencies among health personnel who are in charge of these procedures. It is known that the placement of catheters by extraluminal route, has a higher incidence of infection because it is placed ascendingly and is the most common way to cause a urinary tract infection. In a large majority of infections, its causative agents are given by Gram-negative bacteria and with the appearance of resistance to antimicrobials, it has become a great concern on the part of health personnel. At the same time, it is necessary to recognize the need to indicate antimicrobial therapy when placing the catheter.

Background and Objectives: The common fibular nerve (CFN) has anatomical variance between individuals as it transitions from the posterior thigh to the anterior leg. The nerve s course around the fibular neck is of particular interest, where it becomes vulnerable to injury at the lateral knee. Therefore, we sought to compare factors that may predict distal CFN variability, such as height, age, sex, fibular length, and proximal sciatic variations, which individually or cumulatively play a role in predicting clinically significant locations where the CFN commonly transitions among certain populations. Methods: In this cadaveric study, twenty anatomically-fixed specimens were analyzed, ten males and ten females. Data gathered included age, sex, height, CFN transition point measured from the proximal head of the fibular to the point 90 degrees off the midline of the fibula where the CFN courses around the fibular neck, fibular length, and proximal sciatic nerve variations characterized based on the Beaton and Anson classification system. Factors were compared and statistical values were generated. Results: There was a statistically significant difference between CFN transition points compared to fibular lengths, heights, and between sexes. Sciatic nerve (SN) bifurcation levels and exits were bilaterally identical on all cadavers. All SN exits were Beaton and Anson type 1 (undivided nerve below and undivided piriformis), and bifurcation levels were 20% high, 25% middle, and 55% low. Conclusions: This study highlights the importance of considering a person s height, fibular length, and sex when addressing injuries involving the CFN at the lateral leg.

The group of women of childbearing age is one phase to prepare the next generation of quality. Inadequate food intake can cause Chronic Energy Deficiency problems in women of childbearing age. In women, symptoms of depression worsen the relationship between emotional eating and food intake.The purpose of this study was to determine the relationship between emotional eating and the level of nutritional adequacy of women of childbearing age in the Rimau Islands, Sumur Village, South Lampung.This study used a cross sectional or cross-sectional design. Researchers used the Dutch Eating Behavior Questionnaire (DEBQ) which has been translated into Indonesian, specifically for Emotional Eating and Nutrisurvey to see the amount of food intake of respondents. This study included 20 respondents from 30 respondents who attended. The correlation test for emotional eating on the level of nutritional adequacy (Energy, Protein, Fat, and Carbohydrates) had no relationship with p-values ??(0.649; 0.700; 0.579; 0.675). The conclusion of this study is that there is no relationship between emotional eating and the level of nutritional adequacy (Energy, Protein, Fat and Carbohydrates)

Ayurveda a stream of science in which miraculous properties of various dravyas are hidden. These give us all the required contents in its vegetations, minerals and metals etc. Among these, iron is very essential micronutrient for body which is required for essential biochemical & biological reactions within body. Among all the Ayurvedic preparations, Navayas Loh is that formulation which contains eight iron containing plant parts and one metal that helps to treat anaemia, heart diseases, skin diseases, piles and jaundice etc. Anaemia is a serious global public health problem of today’s era and it particularly imparts its affect on young children and pregnant women. WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anaemic. Anaemia is a condition of deficiency of haemoglobin concenteration in body. Haemoglobin has oxygen carrying capacity and should remain within normal limits in body for normal functioning of body otherwise symptoms like fatigue, dizziness, dyspnoea may occur. Nutritional deficiency is the major reason of anaemia these days. This article will make the way to good health approach via Ayurveda.

Background: Dilated Cardiomyopathy (DCM) is characterized by dilation of the left ventricle (LV) and, by consequence contractile dysfunction. DCM is caused by multiple etiologies, often the result of myocarditis, alcohol consumption, drugs and metabolic or endocrine alterations. Case: We report the case of a 36-year-old patient with a 27.6-week pregnancy with a pathological history of Heart Failure (HF) of 4 years, alcoholism of more than 15 years, methamphetamine use of more than 3 years. She presented agitation and class III dyspnea, the fatigue progressed until she presented respiratory distress accompanied by edema of the lower limbs, an echocardiogram was performed, Dilated Cardiomyopathy was diagnosed and therefore primary management was made with levosimendan and diuretic then cesarean surgery was performed. Conclusion: for this patient the use of levosimendan was beneficial, improving the symptomatology, increasing the cardiac function and making possible the performance of the cesarean delivery. There was no harm for the patient or the baby.

Introduction. Assessing nutritional status has become an essential practice in the critically ill patient, the tools available to the clinician such as anthropometric measurements are inaccurate in obese patients, so it has been necessary to look for other available options such as muscle ultrasound, which has become a novel way to the evaluation of nutritional status and muscle structure of critically ill patients regardless of their body mass index (BMI). Recent studies demonstrate a positive correlation between sonography and total nitrogen balance (TNB) for measuring nutritional status, both of which are considered to be able to assess the nutritional status of overweight and obese patients. Objective. To correlate sonographic muscle measurements of the vastus intermedius (VI) and rectus femoris (RF) with the TNB in the nutritional assessment of critically ill overweight and obese patients. Material and methods. A descriptive, prospective, analytical study in which 30 patients were included. Sonographic measurement of RF and VI muscle thickness was performed simultaneously with TNB on day zero (admission) and five (control). The population was divided into groups according to BMI (overweight, class I obesity, class II obesity, class III obesity). Sonographic measurements were correlated with the TNB measured in the patients. Results. In the initial sonographic measurements, a moderate correlation was found with the TNB at admission. In the group comparison at five days, a strong correlation was demonstrated in the AP diameter of the VI muscle (r=-0.609, p=0.001.) In the initial and control cross-sectional area in cm2 (CSA), a positive correlation was observed (r=0.213 and r=0.258, respectively). Conclusion. There is an inverse correlation between sonographic measurements of RF and VI muscles with TNB in critically ill overweight and obese patients. A positive correlation between CSA of both muscles with the biochemical parameter is reported.

Background: High intraocular pressure (IOP) peaks and fluctuations which are among the significant risk factors for glaucoma development and progression can be detected through water drinking test (WDT) and phasing. Aim: To determine the time of peak IOP during WDT and modified phasing among primary open angle glaucoma (POAG) patients on medical treatment at Enugu State University of Science and Technology Teaching Hospital Parklane (ESUTTHP), Enugu. Methodology: The study was a hospital based cross sectional study on POAG patients on medical treatment attending the eye clinic of ESUTTHP, Enugu. One hundred and thirty patients were selected by simple random sampling. Their eyes were examined which included visual acuity assessment, follow-up clinic intraocular pressure measurement, gonioscopy, anterior and posterior segments examination. WDT and modified phasing were carried out on them. WDT was done over 2 hours after intake of 1 liter of water with intraocular pressure measured every 15 minutes. Modified phasing was done over 8 hours with intraocular pressure measured at 2 hourly intervals. Data analysis was done using SPSS version 20 (U.S.A). Results: A total of 130 POAG patients (260 eyes) on medical treatment were examined comprising of 56 males (43.1%) and 74 females (56.9%). Their age ranged between 42 and 83 years with mean age of 62.25 ± 9.002. The peak IOP occurred in 90.2% of patients within the first 1 hour of water drinking test with 23.6% of the eyes having peak IOP at 15 minutes, 24.0% at 30 minutes, 22.9% at 45 minutes, 20.2% of eyes at 60 minutes, 6.6% of eyes at 75 minutes, 2.3% at 90 minutes, 0.0% at 105 minutes and 0.4% at 120 minutes. The peak IOP occurred in two-thirds (74.1%) of eyes within the first 4 hours of commencing modified phasing while 25.8% had their IOP peak after 4 hours with 30.6% of the eyes having peak IOP at onset of the test, 28.2% at 2 hours, 15.3% at 4 hours, 16.1% at 6 hours and 9.7% at 8 hours. Conclusion: WDT may be done over 1 hour instead of 2 hours as a quick clinic test to detect IOP peaks among glaucoma patients on treatment. Some POAG patients also have IOP peaks occurring in the afternoon during modified phasing and such peaks should not be missed in those patient’s management.

An anal fissure is a tear or ulceration in the lining of the anal canal below the mucocutaneous junction. Medical treatment cures an anal fissure typical in most patients. Because sphincter preservation is important for patients who often have chronic diarrhea, fissures in Crohns patients are usually treated medically rather than surgically. A lateral sphincterotomy is reserved for Crohns patients with minimal active anorectal inflammation who fail all available non-surgical therapies. Medical treatment is often used as an initial treatment of an anal fissure. Surgery is reserved for patients in whom medical treatment fails.

Introduction: The hip is among the most solid joints within the human body that took a lot of force to dislocate it. Hip dislocation is frequently associated with acetabulum fracture. Although traumatic posterior hip dislocation is rarely involved anterior column fracture.

Zenkers diverticulum (ZD) is a sac-like evagination of the mucosa and submucosa through the Killian triangle, an area of muscle weakness between the transverse fibers of the cricopharyngeal muscle and the oblique fibers of the inferior inferior constrictor muscle.