The coverage of soft tissue deficit of the heel, continues to represent a great surgical challenge due to the unique features in this area, developed to withstand large axial and shear loads. The coverage of the heel wounds is considered a priority through an adequate and lasting surgical option that will be the result of a decrease in the morbidity and mortality of the patient.

Necrotizing fasciitis (NF) is a severe, life-threatening, and rapidly progressive soft tissue infection. It is characterized by myonecrosis and necrotizing cellulitis, which requires expeditious surgical debridement. We report a rare case of necrotizing fasciitis caused by Staphylococcus haemolyticus and Escherichia coli in 21-years-old male patient with history of surgery and using a traditional medication at the right thigh. The patient is underwent an extensive debridement, OREF, and treated with prompt antibiotics in the intensive care unit.

Diverticular disease is a common gastrointestinal condition that primarily affects the colon. It is characterized by the presence of small pouches or diverticula in the wall of the colon. Although diverticular disease can affect people of different ages, it is more prevalent as we age. Understanding this diseases epidemiology, pathophysiology, diagnosis, and treatment is essential to provide optimal management to patients. Continued research in this field is needed to improve prevention, diagnosis and treatment options, to reduce the burden of diverticular disease and improve patients quality of life.

Choledocholithiasis is a medical condition characterized by the presence of gallstones in the choledochus, also known as common bile duct. Understanding the epidemiology, diagnosis, and treatment of this disease is essential to providing quality care to patients. Treatment options range from conservative management to interventional procedures such as ERCP and laparoscopic surgery. The choice of therapeutic approach will depend on the comprehensive evaluation of the patient and the discussion between the doctor and the patient, aiming to achieve the best clinical outcomes and improve quality of life.

Fiber Optic Bronchoscopy (FOB) is an invasive procedure that has been traditionally used both as diagnostic and therapeutic purposes in the field of pulmonary diseases. However, it is mainly used as diagnostic method in lung cancer diagnosis, followed by appropriate sampling procedures including needle aspiration, forceps biopsy, brushing, and washing. We aim to characterize the profile of FOB results including the positivity rate (the rate in which pathology results yield either class IV or class V cells) of each FOB procedure. This is an observational descriptive study using retrospective approach using existing FOB results from our patients. The most common FOB finding was compressive stenosis (35.4%), followed by obstructive (34.8%), and infiltrative stenosis (29.8%). Positivity rate for needle aspiration was 50% for infiltrative and 57.15% for obstructive stenosis; Positivity rate for forceps biopsy was 42.1% for infiltrative and 73.33% for obstructive stenosis; Positivity rate for brushing was 6.66% for compressive, 38.24% for infiltrative, and 25.72% for obstructive stenosis; and positivity rate of washing was 5.36% for compressive, 17.54% for infiltrative, and 6.12% for obstructive stenosis. These results showed that as the main method in lung cancer diagnosis, FOB procedures have excellent results depending on the choice of sampling procedures used based on FOB findings.

Hiatal hernias are classified according to their anatomy into: Type I hiatal hernia, or sliding hiatal hernia, Type II (paraesophageal) hernia, Type III (mixed) and Type IV hiatal hernia is associated with a large defect in the phrenoesophageal membrane. Type IV hiatal hernia is a rare pathology with a low incidence in medical practice, but with great clinical relevance due to the risk of imminent morbidity; it is commonly repaired once identified due to concerns of acute gastric volvulus and strangulation of the stomach, although herniation and strangulation of some other intra-abdominal organ is not exempt. We present the clinical case of a patient with a grade IV hiatal hernia, incidental finding, relatively asymptomatic prior to clinical evaluation, repaired by laparoscopy; Performing reduction of the herniation of intra-abdominal organs, diaphragmatic plasty and fundoplication successfully, with a post-surgical evolution that was adequate.

The Cardiorenal Syndrome (CRS) is a complex clinical entity that involves a bidirectional interaction between the heart and kidneys, with a high incidence among patients with cardiovascular and renal diseases. Volume overload is a central feature of CRS, and its optimal management poses a challenge for healthcare professionals. In this context, both the intensive use of diuretics and ultrafiltration have gained prominence as therapeutic strategies to address volume overload and alleviate systemic congestion in patients with CRS. Objective: This review aims to critically compare the efficacy, safety, and practical considerations of the intensive use of diuretics versus ultrafiltration in the management of volume overload in CRS. Methods: A comprehensive review of the literature was conducted, encompassing studies, clinical trials, and meta-analyses comparing the two therapeutic approaches in CRS. Results: The intensive use of diuretics, particularly loop diuretics, has been widely employed due to its rapid action and availability in various clinical settings. Diuretics effectively increase sodium and water excretion, resulting in reduced circulating volume and relief of pulmonary and peripheral congestion. On the other hand, ultrafiltration offers a more precise and controlled elimination of fluids, potentially benefitting patients sensitive to fluid and electrolyte imbalances. Ultrafiltration may be a viable option in patients with diuretic resistance or those at risk of electrolyte depletion. However, current evidence is limited and inconclusive regarding the superiority of one strategy over the other in terms of efficacy. Conclusion: The choice between the intensive use of diuretics and ultrafiltration should be based on individualized patient assessment, considering the severity of volume overload, renal function, diuretic tolerance, and comorbidities. Both therapeutic approaches have advantages and drawbacks, and a one-size-fits-all approach is not suitable for CRS management. Further large-scale, well-designed clinical trials are required to establish the optimal therapeutic approach in CRS. Multidisciplinary collaboration and personalized treatment based on evidence and clinical experience are crucial for optimizing clinical outcomes and improving the quality of life of patients with CRS and volume overload.

Rhinoplasty, a popular cosmetic surgery, offers two primary techniques: open and closed. This literature review compares the theoretical framework, surgical treatment, and complications of both approaches. While the closed technique provides no visible external scars and shorter surgical time, the open technique offers improved precision for complex cases. Both techniques have unique advantages, and the choice should be tailored to individual patient characteristics and desired outcomes. Ongoing research will continue to enhance rhinoplasty techniques and outcomes.

Background. Human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C virus (HCV) are transfusion-transmittable infections (TTI). They currently constitute a major public health problem in Cameroon, like in other developing countries. Little is known about the seroprevalence of HIV, HBV, HCV, and syphilis among blood donors in northern region Cameroun. This study aims at filling the gap on the unknown sero-prevalence of those markers in blood donors. Methods. We conducted a cross-sectional study from June 04, to July 08, 2022 at the Garoua Regional Hospital Blood Bank (GRHBB). A total of 201donors were consecutively included and data on donor’s sociodemographic characteristics were obtained by the national program’s questionnaire. Serum samples from blood donors were tested using sensitive third generation Rapid diagnostic test (RDT) for presence of Hepatits B surface antigens (HBsAg), and antibodies to human immunodeficiency (HIV-1/2), Hepatits C (HCV) and Treponema pallidum; and quantitative enzyme-linked immunosorbent assays (ELISA) served for confirmation. Data were collected and entered into an Excel sheet and then exported to SPSS version 20.0 for analysis. Results. A total of 201 blood donors were identified and the sex ratio (male/female) was 7/1, with a mean age of 32.12 ± 8.4 years (range: 19 to 57 years). Of all blood donors, 35/201 (17.4%) were infested by at least one of the four TTIs. Among blood donors, HIV, HBV, HCV and syphilis were 5 (2.5%); 26 (12.9%); 1 (0.5%) and 5 (2.5%), respectively. Co-infection with HIV-Syphilis was 1 (0.5%); and HBV-HCV 1 (0.5%). Conclusions. This study has revealed the high prevalence of TTIs in blood donors who attended the Garoua Regional Hospital Blood Bank, identifying Hepatitis B as the greatest threat to blood safety in the North Region of Cameroon.

In the renal calyces and pelvis, mineral deposits known as kidney stones can be found either loosely or firmly attached to the renal papillae. They comprise both crystalline and organic molecules and are produced when the urine is very saturated with a specific mineral. The majority of stones are mostly formed of calcium oxalate, and a lot of these stones form on Randalls plaques on the renal papillary floor, which are made of calcium phosphate. In the first five years after the initial stone episode, charges of up to 50% may recur. There are charges of up to 14.8% and increasing for stone creation. Risk factors for kidney stone development include obesity, diabetes, high blood pressure, and metabolic syndrome. Kidney stones can then lead to hypertension, chronic kidney disease, and end-stage renal disease. Less invasive endourological techniques have replaced open surgical lithotomy for the treatment of symptomatic kidney stones, reducing patient morbidity, increasing stone-free rates, and improving quality of life. Prevention of recurrence requires behavioral and nutritional adjustments in addition to drugs according to the kind of stone. The creation of stronger capsules and the pressing need for recurrence prevention necessitate a greater comprehension of the mechanisms behind stone formation.

The slipped capital femoral epiphysis is the most frequent lesion of the hip in children between the ages of 8 and 15. They are classified according to the stability of the physis in stable and unstable. This pathology needs to be quickly diagnosed and treated due to its consequences. Several predisposing factors have been identified including endocrinological pathologies and genetic disorders. It is a pathology that is extremely rare in people older than 18 years of age. The Kallmann Syndrome is the association of congenital hypogonadotropic hypogonadism (CHh) a strange disorder caused by the deficient production, secretion or action of the Gonadotropin-releasing hormone (GnRH) and deficient sense of smell (anosmia or hyposmia)

Background: Recurrent pregnancy loss were prevalent complications in pregnancy. Immunological biomarkers as Neopterin used as a marker in recurrent pregnancy loss. Anti-Mullerian hormone is a reliable marker of the ovarian reserve. Therefore, was also considered as a marker to evaluate its role in the recurrent pregnancy losses. This study was conducted to assess whether neopterin and Anti- Mullerian hormone can be used as a marker in the condition of unexplained recurrent pregnancy loss. Materials and Methods: A case control study was done in the Department of Obstetrics and Gynecology Salahdeen general hospital in Tikrit city from first January to thirty of August 2020. One hundred patient enrolled in the study. Study contains two groups:1- Group A as cases. 2- Group B as control group. The data collection done through:1-Designed closed and open-ended questionnaire, 2- Laboratory investigations of : Serum Neopterin and Anti-Mullerian hormone levels using enzyme-linked immunosorbent assay. Results: Mean Neopterin level was significantly higher among cases (24.3±10.7)nml/l than control group (2.9±1.1) nml/l. Mean Neopterin level increased with increasing abortion number. It was significantly higher among those with =5 abortions (30.02±10.04) nml/l than those with (3-4) and 2 abortions (28.7±15.29) nml/l and (20.1±0.03) nml/l. The mean Neopterin level increased with increasing age among cases and controls. Among cases was (28.7±12.03) nmol/L among those aged (31- 35) year, which was higher than those aged (18-25), and those aged (26-35) years Mean Anti-Mullerian hormone level was significantly lower among cases (0.8±0.6) ng/ml than control group (5.01±2.7) ng/ml. Mean Anti-Mullerian hormone level was significantly higher among those with 2 abortions (1.06±0.7) ng/ml than those with (3-4) and 5 abortions (0.6±0.56) ng/ml and (0.97±0.4) ng/ml respectively. Among case the mean AMH level was lower among those aged (31-35) years (0.5±0.31) ng/ml than those aged (26-30), and (18-25) years (0.8±0.7) ng/ml, (0.97±0.7) ng/ml, respectively Conclusions: A statistically significant high Mean Neopterin level among cases and its increased mean Neopterin level with increasing abortion number. A statistically significant low levels of mean Anti-Mullerian hormone level among cases, more reduction in its level with increasing abortion. This pioneer study in Iraq, determined the significant association between the unexplained recurrent pregnancy loss with the increased levels of Neopterin and its effect on Anti-Mullerian hormone that lead to recurrent pregnancy loss.

Dilated cardiomyopathy is the most common form of cardiomyopathy in children, is the cause of significant morbidity and mortality. Although the most common etiology of DCM remains idiopathic, it is estimated that upto 50% of cases are genetic. The pathogenesis of ventricular dilation and altered contractility seen in DCM varies depending on the underlying etiology; systolic dysfunction and myocyte injury are common. Takayasu arteritis also known as “pulseless disease”, is a chronic large vessel vasculitis of unknown etiology and predominantly involves the aorta and its major branches. This disease is most common in Asians and mostly diagnosed in adolescent age group, on average at the age of 13 years. TA is characterized by inflammation of the vessel wall starting from vasa vasorum. Persistent inflammation leads to progressive scarring and intimal proliferation and can result in stenotic or occluded vessels leading to systemic manifestations. We have reported a rare case of dilated cardiomyopathy along with Takayasu arteritis in a preschool child. The causality and association between both the conditions has not been fully understood yet. However DCM has been reported in only 5-6% cases of TA.

Grafts play a pivotal role in plastic surgery, providing essential solutions for reconstructive and aesthetic challenges. This literature review explores the epidemiology, significance, theoretical framework, and implications of grafts in plastic surgery. The epidemiology highlights the increasing utilization of grafts in diverse patient populations, addressing various anatomical defects and aesthetic concerns. The significance of grafts lies in their capacity to restore form and function, enhancing patients quality of life and self-esteem. The theoretical framework encompasses the classification of grafts, surgical techniques, and potential complications. Autografts, allografts, xenografts, and synthetic grafts offer versatility in addressing patient-specific needs. Microsurgical techniques and biomaterial advancements have improved graft survival rates. Balancing aesthetic goals and safety remains crucial in achieving desirable outcomes. Ongoing research in grafting materials and techniques presents exciting prospects, including regenerative approaches and personalized grafting solutions. Challenges include selecting the most suitable graft and ensuring long-term monitoring for complications. This review highlights the vital role of grafts in plastic surgery, underlining the need for ongoing research and multidisciplinary collaboration to optimize patient outcomes and advance the field.

Pityriasis rosea of Gibert is a common, self-limiting dermatologic entity that continues to raise questions regarding its etiology, diagnosis, and clinical management. This comprehensive review focuses on analyzing the distinctive clinical presentation of pityriasis rosea, characterized by the appearance of a herald patch followed by multiple secondary collarete or Christmas tree lesions. Although the exact cause of this disease remains unknown, a possible relationship with an immune reaction triggered by a previous viral infection or environmental factors yet to be identified is postulated. Through a thorough literature search, current findings on the epidemiology, pathogenesis and clinical diagnosis of pityriasis rosea are evaluated. The importance of the clinicians clinical judgment and accurate identification of the distinctive features of the skin lesions to reach an accurate diagnosis is emphasized. Although pityriasis rosea is usually asymptomatic or causes mild pruritus in most cases, symptomatic therapeutic options, such as the use of oral antihistamines and low potency topical corticosteroids, are described to alleviate patient discomfort when necessary. Patient education and psychological support are essential to decrease the anxiety associated with skin lesions and to provide reassurance during the self-limiting course of this condition. In the context of the clinical and epidemiologic relevance of pityriasis rosea, the need for continued research to improve understanding of its etiology and management arises. Although pityriasis rosea does not represent a serious health threat, its high frequency in the population and its distinctive clinical appearance underscore the importance of empathetic and compassionate medical care to ensure the patients well-being during the process of spontaneous resolution.

Endocarditis is defined as an infection of the cardiac endothelium. The incidence occurs from 2 to 10 cases per 100,000 people/year. Cardiovascular complications, including cardiac arrest, cardiogenic shock, myocardial infarction, acute heart failure, and heart block. The case of a 51-year-old male patient with fever, asthenia, adynamia, and chills is presented, evolving to shock data to determine the origin, requiring management with vasopressor, a diagnostic protocol with transthoracic echocardiogram is performed where calcified aortic valve and mass attached to the valve ring and image suggestive of abscess at the level of the sinuses of Valsalva are observed. Transesophageal echocardiogram, in addition to the vegetation previously described and the abscess in the mitro-aortic continuity, tricuspid valve lesion with rupture of the sinus of Valsalva. Consultation was requested for cardiothoracic surgery with aortic valve replacement due to a N23 mechanical valve, with closure of the right sinus of Valsalva ruptured to the right ventricle infective endocarditis of the aortic and tricuspid valve with clinical improvement if any eventualities occurred. Rupture of the sinus of Valsalva with fistulization towards lower-pressure cavities (generally the right atrium and ventricle) is probably the most frequent form of presentation. Accurate diagnosis of complicated infective endocarditis means the difference between a good evolution and a poor prognosis.

Bile duct interruption, or biliary obstruction, is a condition characterized by the partial or complete blockage of the bile ducts, impeding the normal flow of bile from the liver to the small intestine. This literature review explores the epidemiology, significance, theoretical framework, and management of bile duct interruption. The epidemiology of this condition is influenced by various factors, including the prevalence of gallstones and other biliary pathologies in different populations. Bile duct interruption carries significant clinical significance due to its potential to cause jaundice, pruritus, and serious complications such as cholangitis and liver abscesses. The theoretical framework delves into the definition of bile duct interruption, surgical treatment options, and potential complications. Surgical interventions, including cholecystectomy, endoscopic procedures, and liver transplantation, are utilized to address different causes of bile duct obstruction. However, despite advancements in treatment, complications such as bile leakage, infections, and strictures can occur. The discussion underscores the need for a multidisciplinary approach involving gastroenterologists, hepatobiliary surgeons, and transplant specialists to optimize patient outcomes. Future research should focus on refining surgical techniques, exploring innovative endoscopic interventions, and improving long-term prognosis for patients with bile duct interruption. Comprehensive management strategies and ongoing research advancements hold promise for enhancing patient care and reducing the morbidity associated with bile duct interruption.

Advances in regenerative therapy have sparked significant interest in the field of auricular reconstruction for congenital microtia. Congenital microtia is a rare congenital deformity characterized by underdevelopment or absence of the external ear. Traditional surgical approaches using autologous grafts or artificial implants have limitations. Regenerative therapy offers innovative solutions by leveraging tissue engineering, biomaterials, and stem cells to create patient-specific and anatomically accurate external ears. This literature review explores the theoretical framework, surgical treatment, and potential complications of regenerative therapy for auricular reconstruction. Promising outcomes and future perspectives highlight the potential of regenerative therapy in providing more natural, functional, and personalized solutions for individuals with congenital microtia. Continued research and collaboration are crucial to advancing this field and improving the lives of those affected by microtia.

Breast reconstruction is an essential component of breast cancer management, aiming to restore the physical appearance and emotional well-being of patients who have undergone mastectomy or lumpectomy. Two primary approaches, implant-based reconstruction and autologous tissue reconstruction, offer distinct advantages and considerations. Implant-based reconstruction involves the use of silicone or saline breast implants, offering a less invasive surgical procedure and shorter recovery time. However, potential complications, such as implant malposition and capsular contracture, should be carefully considered. Autologous tissue reconstruction utilizes the patients own tissues to reconstruct the breast, providing a more natural outcome. While this method may involve a more complex surgery and longer recovery time, it avoids the use of foreign materials. The choice between these approaches is multifaceted and involves patient preferences, anatomical considerations, previous treatments, and overall health status. Shared decision-making between patients and healthcare professionals is crucial to achieving patient satisfaction and optimal outcomes. Breast reconstruction plays a significant role in supporting breast cancer survivors on their journey towards physical and emotional healing, empowering them to embrace their new identity and regain a positive body image. Continued research and advancements in breast reconstruction techniques hold promise for further improving patient outcomes and enhancing quality of life.

Tendon grafts play a crucial role in reconstructive surgery, restoring function and stability to damaged tendons. This literature review examines the theoretical framework, surgical treatment, and potential complications associated with different types of tendon grafts. Autografts, harvested from the patients own body, are considered the gold standard due to their biocompatibility and better integration. Allografts and synthetic grafts offer alternatives, eliminating donor site morbidity and providing consistent biomechanical properties. However, considerations include the risk of graft rejection and inferior mechanical performance. The selection of the most suitable graft should be tailored to individual patient needs, optimizing functional outcomes and patient satisfaction. Advances in graft technology continue to shape the landscape of reconstructive surgery, further enhancing patient outcomes and quality of life

Nerve reconstruction in the hand is a critical aspect of hand surgery, aiming to restore sensory and motor function and improve overall hand functionality. Intraoperative nerve conduction, a neurophysiological technique, plays a pivotal role in nerve reconstruction surgeries. This literature review evaluates the efficacy and results of intraoperative nerve conduction in hand nerve reconstruction. Theoretical Framework: Intraoperative nerve conduction involves electrical stimulation of nerve fibers and the recording of nerve conduction responses in real-time during surgery. The technique aids in nerve identification, assessment, and surgical decision-making. Discussion: Intraoperative nerve conduction has shown efficacy in guiding surgical interventions and predicting postoperative outcomes. It has been particularly useful in complex nerve injuries, providing valuable feedback for optimal surgical planning. Challenges: Despite its benefits, intraoperative nerve conduction has limitations, such as timing issues and the need for skilled neurophysiologists and specialized equipment. Future Implications: Standardizing protocols and conducting larger prospective studies can enhance its reliability and identify specific scenarios where intraoperative nerve conduction provides the greatest benefit. Conclusion: Intraoperative nerve conduction is a valuable tool in hand nerve reconstruction, contributing to improved patient outcomes and the advancement of hand surgery. Continued research and technological advancements hold promise for its further optimization and wider applicability in the field.

The coverage of soft tissue deficit of the heel, continues to represent a great surgical challenge due to the unique features in this area, developed to withstand large axial and shear loads. The coverage of the heel wounds is considered a priority through an adequate and lasting surgical option that will be the result of a decrease in the morbidity and mortality of the patient.

An acquired diaphragmatic hernia usually occurs after thoracoabdominal trauma, causing a defect in the diaphragm that allows the migration of intraperitoneal structures into the thoracic cavity. The finding of renal involvement has a low incidence. The diagnosis of diaphragmatic hernias is based on chest x-ray and computed tomography. Treatment is surgical, due to the risk of strangulation, and consists of content reduction, resection of the sac, and closure of the hernia defect. It can be performed through the thoracic or abdominal approach, with an increasing number of minimally invasive techniques, which reduce trans and postoperative complications. We present the case of a patient with a diagnosis of late-onset post-traumatic diaphragmatic hernia with renal involvement, treated surgically through a thoracic approach with an attempt to preserve the kidneys, who finally underwent nephrectomy due to urinoma secondary to a lesion of the renal pelvis during the mobilization of the kidney to the abdominal cavity.

Glioblastoma is the most common and most aggressive tumor of the central nervous system whose morbidity and mortality remain very high despite all types of treatment (surgical resection, local and systemic chemotherapy). Numerous associated molecular alterations have been reported, but only a few are associated with survival. Despite several investigations and discoveries about this pathology, the survival rate is still very low. However, tumor markers are not currently taken much into account and these are often of importance as they can see the cause and even predict or diagnose early. The purpose of this research is to show the importance of glioblastoma tumor markers as part of the diagnosis of this disease, and also how they influence the choice of treatment, since, according to molecular genetics, according to the results found in this research, there are a variety of markers that increase helping us to identify the pathology and at the same time, if neutralized, can help favorably to the treatment and prognosis of the patient. Such is the case of the YKL40 marker, LRP, RAP, ApoE3, GOLM1, TROY and angiopep-2.

Dermatofibrosarcoma protuberans (DFSP) is a rare and locally aggressive mesenchymal neoplasm arising from the dermal and subcutaneous tissues. It typically manifests as a slow-growing, firm, protuberant or plaque-like lesion on the skin. DFSP predominantly affects young to middle-aged adults, with a slight predilection for females. This tumor exhibits a distinctive infiltrative growth pattern, characterized by tumor cells invading the surrounding tissues, including the deep subcutaneous layers and the underlying fascia. Histopathologically, DFSP presents characteristic features, such as the presence of spindle-shaped tumor cells arranged in a "storiform" pattern, as well as the presence of a prominent "honeycomb" appearance due to the presence of multinucleated giant cells. Immunohistochemical staining is essential to confirm the diagnosis, with positivity for CD34 being a hallmark of DFSP. Although DFSP rarely metastasizes, its extensive local invasion and high recurrence rate necessitate a wide surgical excision with clear margins as the mainstay of treatment. The use of Mohs micrographic surgery or adjuvant radiation therapy has demonstrated favorable outcomes in cases with challenging anatomical locations or microscopically positive margins. Imatinib mesylate, a tyrosine kinase inhibitor, has also emerged as a promising systemic therapy for advanced or unresectable DFSP, particularly cases with the COL1A1-PDGFB gene fusion, which represents the molecular hallmark of DFSP. Early diagnosis and appropriate management are crucial to achieving optimal outcomes in DFSP. This article provides a comprehensive review of the clinical, histopathological, and molecular aspects of DFSP, highlighting the significance of a multidisciplinary approach to ensure accurate diagnosis and tailored therapeutic strategies for patients affected by this rare dermatological neoplasm.

Systemic scleroderma, a complex and rare autoimmune connective tissue disease, represents a significant clinical and scientific challenge due to its clinical heterogeneity, multisystem involvement, and potential for severe disability and complications. This article examines in depth the epidemiological, clinical, diagnostic and therapeutic aspects associated with this complex condition. Through a comprehensive review, it highlights the importance of a multidisciplinary medical approach to properly evaluate and manage the disease, from early detection to the implementation of specific therapeutic strategies targeting affected organs and systems. It also emphasizes the need for continued research to better understand the underlying pathogenic mechanisms and develop more effective therapies, with the goal of improving the outcomes and quality of life of patients affected by this complex autoimmune condition.

Pemphigus belongs to the group of antibody mediated autoimmune vesiculobullous disease (AIBD) of skin and mucous membranes. Antibodies are directed against the desmosomal adhesion proteins and IgG4 is the predominant subclass. It is a rare disease associated with significant mortality and morbidity. DIF is the gold standard test for AIBD. It requires fresh frozen section which is a major technical issue in most centres. The aim of this research was to study the diagnostic accuracy of IgG4 immunohistochemistry in pemphigus. The study was conducted as a diagnostic test evaluation in a tertiary care hospital. Paraffin blocks of histopathologically diagnosed AIBD were used for doing immunohistochemistry. The findings were compared with DIF findings. Statistical analysis was performed using SPSS, version 20.0. 48 paraffin blocks of AIBD were selected, DIF of all cases were already done from outside centre. There were 21 cases of pemphigus, 25 cases of bullous pemphigoid and one case each of epidermolysis bullosa acquisita and dermatitis herpetiformis. The sensitivity of IgG4 IHC was found to be 85.7%, specificity 96.3%, positive predictive value of 94.7% and negative predictive value 89.7%. So, we conclude that IgG4 IHC done on paraffin sections can be used as a diagnostic tool for pemphigus.

Pemphigus bullosus, also known as pemphigus vulgaris, is a rare and potentially serious autoimmune disease affecting the skin and mucous membranes, characterized by the formation of intraepidermal blisters due to the loss of cellular cohesion at desmosomal junctions. In this article, we present a comprehensive review of the entity, covering its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and therapeutic options. We highlight the complexity and diagnostic challenges associated with bullous pemphigus, emphasizing the importance of careful clinicopathologic and immunofluorescent correlation for its proper identification. We also discuss in detail the multidisciplinary therapeutic approach required to achieve disease control, emphasizing the use of systemic immunosuppressants and biological therapies. In addition, we highlight the relevance of local therapy and care management, along with the need for close medical follow-up to assess response to treatment and minimize adverse effects. Finally, we highlight the importance of continued research in this complex clinical entity, in order to improve the understanding of its immunopathological mechanisms and to develop more specific and personalized therapies. In conclusion, this article provides a comprehensive and updated view of bullous pemphigus, with the aim of improving its clinical management and promoting a more efficient and effective therapeutic approach.

Introduction: The COVID 19 pandemic generated in December 2019 has come to change paradigms in terms of ventilatory support measures worldwide, continuous clinical monitoring allows timely decision making impacting mortality in patients with ARDS. Objective: To identify the relationship between the SO2/FiO2 delta and mortality in critically ill patients with ARDS and COVID-19 in prone position. Material and methods: Retrospective, observational, comparative, analytical study, where all patients who met the inclusion criteria were evaluated: under mechanical ventilation and prone position for acute respiratory failure secondary to SARS-CoV-2 infection, measuring the value of SO2/FiO2 before and after the change of position to prone position, also mortality was recorded. Results: A total of 74 patients were analyzed, 33 corresponding to the survivors and 41 to the non-survivors group. The median age was 53.5 ± 12.77, with a male predominance. The mean days of mechanical ventilation were 10.64 ±5.16. A ROC curve was also performed for D SaO2/FiO2 and survival (AUC 0.668, p=0.013) for predicting patient survival. Conclusion: Continuous clinical monitoring is necessary to optimize resources in the different hospital and out-of-hospital areas. D SO2/FiO2 can be very useful for the continuous monitoring and prognosis in COVID-19 critical patients.

Crohs disease (CD) is a chronic inflammatory bowel disease characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Its increasing incidence and prevalence worldwide underscore the significance of understanding its epidemiology and implications on public health. CD imposes a substantial burden on affected individuals, causing recurrent symptoms, complications, and reduced quality of life. The theoretical framework of CD encompasses its definition, surgical treatment options, and potential complications. Surgical intervention remains a crucial aspect of disease management, with a majority of CD patients requiring surgery at some point during their lifetime. Bowel resection and strictureplasty are commonly employed surgical techniques to address strictures and complications, aiming to preserve intestinal function and improve patient outcomes. Complications, including disease recurrence and postoperative complications, pose challenges in the management of CD. Long-term follow-up and collaboration between medical and surgical teams are essential for optimizing patient care and outcomes. The discussion emphasizes the multidisciplinary approach to CD management, involving gastroenterologists, surgeons, and nutritionists. Minimally invasive techniques and enhanced recovery protocols have improved patient experiences and outcomes. Future research aims to enhance disease understanding, identify biomarkers for disease activity, and explore novel therapeutic targets to improve outcomes and quality of life for patients with CD. In conclusion, CD represents a complex and challenging inflammatory bowel disease with significant implications for patients and healthcare systems. By integrating the theoretical framework, surgical management, and ongoing research efforts, healthcare professionals can optimize CD management and enhance patient outcomes.

Introduction: Pain management education program had an effectiveness in improving knowledge of nurses toward pain management. However, in Vietnam including Hai Duong provincial general hospital, it has never tested. Therefore, this study aim to evaluate the effectiveness a Pain Resource Nurse program on knowledge toward pain management of nurses at Hai Duong provincial General Hospital, Vietnam. Material methods: A quantitative, experimental design was used. Twelfth units were randomly assigned to Pain Resource Nurse program(n=6) and control group(n=6). 47 nurses in each group were randomly selected. The Knowledge and Attitudes Survey Regarding Pain (KASRP) developed and revised by Ferrell and McGrant (2014) was used to assess the knowledge and attitudes of the nurses regarding pain management of nurses at two measurement points [18] . Results: The total number of participants who were surveyed at two measurement points with a completion rate of 100%. Findings revealed that after 1 month of intervention, the percentage of nurses had good knowledge level in the intervention group increased from 19.5% to 53.2%. In contrast, the control group tended to decrease from 31.9% of nurses had good knowledge level to 21.3%. Chi Square test indicated that post intervention one montthere was significant difference between two groups with regard to pain management knowledge level (? 2 = 10.2, p = 0.001) Conclusion: A well-structured education program have a significant positive impact on nurses pain management knowledge.

Introduction: Spontaneous pneumothorax is defined as the abnormal accumulation of air in the pleural space between the lungs and the chest wall, it occurs without an obvious etiology, such as trauma or iatrogenic causes. Primary spontaneous pneumothorax occurs when ther e is no history of underlying lung disease, while secondary spontaneous pneumothorax is associated with a history of underlying lung disease; its diagnosis is based on clinical suspicion and can be confirmed with imaging tests. Case presentation: We prese nt a 17 year old patient who presented spontaneous right pneumothorax, requiring placement of endopleural tube and Heimlich cannula with long stay, discharged for resolution and later relapsing in initial symptomatology one week later, requiring hospital readmission. Conclusion The recidivant spontaneous pneumothorax in the context of a young patient with clinical characteristics like those of our patient: tall stature, pectus excavatum, hyperlaxity of the integuments and aortic-mitral murmur, gives us hig h suspicion of a secondary cause, a good clinical history, with particular focus on the maternalfetal history and a detailed physical examination, are the most useful tools to integrate a diagnosis of connective tissue diseases.

Introduction: Atrioventricular sulcus lesion (AVGD) is a catastrophic complication of mitral valve surgeries that occurs in less than 2% of the population, with a mortality of 90%. Left ventricular rupture after mitral valve (MVR) replacement should be diagnosed immediately and repaired without hesitation. There are numerous complications described and known after MVR, such as thromboembolism, structural valve degeneration and endocarditis, paravalvular leakage, conduction irregularities in the pathway and bleeding. Case presentation: We present the case of a female patient with a history of rheumatic heart disease with double mitral injury and atrial fibrillation, in which severe mitral stenosis was documented with ECOTT reflecting thrombi of heterogeneous appearance occupying almost entirely left atrium. Programmed for left auriculotomy, valve replacement and thrombus exceresis, resulting in the procedure lesion of the atrioventricular groove meriting packing of the same and placement of mediastinal probes, with subsequent admission to post-surgical coronary care unit. Conclusions: At present, atrioventricular groove rupture is a rare event with increased mortality, the incidence depends on age and associated risk factors in the patient, In our case, rheumatic heart disease generates arrhythmias as a procoagulant state. Although the rupture can be repaired in a second surgical time, follow-up and post-operative care require comprehensive medical equipment and continuous hemodynamic surveillance.

Rosacea, a chronic, recurrent skin disease, has long intrigued the medical community because of its complex pathophysiology and varied clinical presentation. In this article, a comprehensive assessment of current advances in understanding the underlying mechanisms of rosacea is presented. Inflammatory processes, neurovascular dysfunction, and possible genetic factors contributing to the development and progression of this condition are explored in detail. In addition, the differential diagnosis of rosacea is discussed in depth, considering its clinical similarities with other dermatologic and vascular diseases, and the most recent diagnostic tools, such as dermoscopy and molecular tests, which have revolutionized diagnostic accuracy, are highlighted. In terms of therapeutic approaches, conventional options such as topical and systemic agents are reviewed, as well as emerging therapies based on modulation of the skin microbiota and inhibition of specific inflammatory mediators. The efficacy and safety of laser therapies and minimally invasive procedures, which have shown promising results in the treatment of rosacea, are discussed. This article offers a comprehensive overview of rosacea from an advanced medical perspective, highlighting advances in the understanding of its pathogenesis and providing a detailed guide to the diagnostic and treatment options currently available. The information presented is intended to inform and guide health care professionals in the optimal management of this complex clinical entity.

Vitiligo, an enigmatic and complex skin disease, is notable for the appearance of depigmented patches that arise due to the selective and progressive loss of melanocytes, the cells responsible for melanin production. This autoimmune pathology affects individuals of both genders and has been the subject of historical interest due to its unusual clinical presentation and its impact on patients quality of life. The etiology of vitiligo is multifactorial, involving a combination of genetic, environmental and autoimmune factors leading to melanocyte destruction. Although diagnosis is usually based on visual examination of the skin lesions, additional tests may be required to rule out other conditions with similar features. Although a definitive cure has not yet been found, a variety of therapeutic approaches, including topical treatments, phototherapy, systemic therapy and surgical options, are available to attempt to repigment affected areas and improve patients quality of life. Continued research and a deeper understanding of the pathogenesis of vitiligo are essential to address this disease more effectively and provide more successful therapeutic solutions.

This literature review article focuses on revascularization in neurosurgery for the management of cerebral vascular diseases. The pathophysiology of conditions, such as strokes and aneurysms, is discussed and various surgical techniques used are discussed, including direct and indirect revascularization, clipping, and aneurysm coiling. The relevance of Dr. Edgar Nathal Vera in this field is highlighted. Although revascularization offers benefits, it also presents risks and complications that require careful evaluation and perioperative strategies. Future research is essential to improve the management of these diseases and optimize the outcomes of revascularization in neurosurgery.

This article presents an exhaustive systematic review of the medical literature focused on the detailed analysis of ureter injuries. Injuries to this anatomical conduit, which connects the kidneys to the bladder, can arise as a consequence of various causes, such as abdominal surgeries, trauma, gynecological and urological procedures, among others. The aim of this study is to provide a comprehensive and updated view of the etiology, epidemiology, classification, clinical manifestations, diagnosis and treatment options for ureteral injuries. During the investigation, numerous scientific articles, case reports, and retrospective studies were extensively reviewed, with particular focus on identifying the risk factors associated with these lesions. Also highlighted were the various diagnostic approaches and imaging tools, including computed tomography (CT), retrograde urography, cystoscopy, and magnetic resonance imaging (MRI), which are critical for the accurate diagnosis and extensive evaluation of ureter injuries. Significant differences in treatment options were observed, depending on the severity and location of the lesions, with endourological and laparoscopic techniques being the preferred options for milder cases, while complex reconstructive surgeries are reserved for more extensive and complex lesions. Innovative surgical techniques, including ureteral anastomosis, tissue grafting and the use of ureteral stents, are addressed with the goal of optimally restoring ureteral function and structure. This systematic review highlights the importance of a multidisciplinary approach in the management of ureteral injuries, involving urologists, general surgeons, gynecologists and radiologists, to ensure timely diagnosis and effective treatment. Furthermore, the relevance of prevention and early identification of ureteral injuries is emphasized, with the purpose of minimizing complications and improving long-term clinical outcomes. In conclusion, this research provides a valuable source of information for the medical and surgical community, promoting a better understanding and comprehensive management of ureteral injuries.

Meningioma, a predominantly benign intracranial neoplasm originating in the meninges, has been the subject of extensive study in the medical community due to its prevalence, clinical diversity, and associated therapeutic challenges. This article aims to provide a comprehensive review of current advances in the understanding, diagnosis and treatment of meningiomas, focusing on the application of multidisciplinary approaches and innovative therapies. Through a detailed exploration of the molecular pathogenesis, updated histopathologic classifications, and varied clinical presentations of meningiomas, an in-depth understanding of the inherent heterogeneity of these neoplasms is sought. The importance of advanced neuroimaging, including diffusion-weighted MRI and positron emission tomography, in the accurate assessment of tumor extent and precise surgical planning will be highlighted. In the therapeutic arena, conventional options, such as surgery and radiation therapy, will be examined in detail and the challenges and limitations associated with these modalities will be discussed. In addition, emerging pharmacologic therapies, such as angiogenesis inhibitors and therapies specifically targeting genetic mutations frequently found in meningiomas, will be reviewed, highlighting their potential to modify the clinical course of the disease. The multidisciplinary approach, involving close collaboration between neurosurgeons, neuroradiologists, pathologists and oncologists, will be explored in detail, highlighting its crucial role in informed clinical decision making and optimizing patient outcomes. Finally, future prospects and areas of ongoing research, such as immunotherapy and gene therapy, which promise to further revolutionize the therapeutic paradigm for meningiomas, will be outlined. This article will provide a comprehensive overview of meningiomas, from their molecular basis to state-of-the-art treatment strategies, with the purpose of enriching medical knowledge and fostering a holistic approach in the care of patients affected by this complex pathological entity.

Objective: This study was conducted to determine the pain severity, pain interference severity with daily activities, and pain-related factors, pain interference-related factors among patients with cancer in Vinh Phuc province. Materials and methods: A cross-sectional descriptive study was conducted on 116 patients with cancer aged 18 years and older in Vinh Phuc province from January 2023 to the end of June 2023. Results: The overall average pain score and pain interference score of cancer patients were 3.64±1.5 and 4.57±1.95. Mild pain at 56.9%, moderate pain at 37.9%, and severe pain at 5.2%. Pain interference was mild 33.6%, moderate 50.9%, severe 13.8%, and no obstacle 1.7%. The factors affecting pain are education (Z=-2.26,p=0.024), disease stage (?2=11.79,p=0.008), pain medication used (?2=74.56,p=0.00), and the patients condition (Z=-4.42,p=0.00). Factors affecting pain interference are education (Z=-2.22,p=0.027), disease stage (?2=9.88,p=0.02), analgesic used (?2=15.75,p=0.00), perfomance status (Z =-7.1,p=0.00), cancer type (?2 = 13.16,p=0.04), and pain of patients (?2 =17.16,p=0.00). Conclusions: Pain and its interference with daily activities in moderate and severe patients with cancer account for a relatively high rate. The pain of patients with cancer was related to education, stage of disease, pain medication used, and performance status (ECOG). These factors and cancer type are associated with pain interference. The pain of patients with cancer is related to pain interference.

Background: Breast cancer is a major global health issue, becoming one of the biggest causes deaths for women around the world, and the most costly type of cancer to treat. Breast cancer is typically diagnosed through a biopsy, an operation that causes the patient an extensive amount of pain and suffering. Recently, studies have focused on using biomarkers to predict and diagnose some types of cancer, including breast cancer. The goal of this study aims to use the blood samples of patients to identify breast cancer using the markers CD117, CK7, and C7. Methods: the case-control study of 62 participants. 31 healthy controls and 31 patients with cancer meeting inclusion criteria, ranging in age from 30 to 74 years. An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of CD117, CK7and C7 biomarkers. Results: the results showed Statistically significant difference P value (< 0.05) between Breast group and control group for BMI, CLDN7 serum, CLDN7 tissue, CK7 serum, CK7 Tissue, CD117 serum and CD117 tissue. Also, shown non- significant difference P value (> 0.05) for Age. Conclusion: As a result of their various concentrations, the C7, CK7, and CD117 biomarkers all have the potential to be utilized to diagnose breast cancer, however only C7 and CK7 have decreasing concentrations in breast cancer compared to a concentration (CD117) that is rising.

Background: The COVID-19 pandemic has heightened awareness of infectious illnesses and their links to host variables and underlying disorders. Objectives: In this review, we look at current research on a possible link between smoking and COVID-19 and study the biomarker changes in patients. Material and Methods: A case-control study included 45 smokers patients with COVID-19 and 50 healthy subjects as a control group who visited Al-Basra Teaching Hospital and Allmwanei Hospital in Al-Basra province between October 2021 and February 2022. The age average for the study population was (25-80) years. Serum and blood levels of human CBC, ESR, CRP, Ferritin, D-Dimer, IL 6, Albumin, FBS, HbA1c, Troponin, Cholesterol, Triglyceride, HDL, LDL, VLDL, Creatinine, Urea, Uric acid and GFR were measured. Results: The results show all biomarkers tend to have high sensitivity and specificity for smoker COVID patients based on the ROC curve analysis: Lymphocyte, CRP, Ferritin, D-Dimer, IL 6, Albumin, FBS, HDL, Creatinine, Urea, and GFR. These biomarkers might be helpful in determining the kind and severity of COVID-19 in smokers. Although the data is limited to a total number of patients. Conclusion: Studying patient alterations and vital signs led to the conclusion that smoking and COVID-19 are related. It was also verified that all vital indicators had strong sensitivity and specificity for smoking COVID patients.

Renal failure is the most important disease that causes losing in the efficiency of kidney and is renal failure or may called end stage kidney disease where capacity for kidney become 15% less than the normal levels .This disease can be classified into two types : first (acute kidney failure ) which may resolve and it rapidly developed .Second (chronic kidney failure) : it slowly developed and may become a permanent condition Symptoms of Renal failure include vomiting; swelling in the legs; a loss of appetite; confusion and tiredness. Several complications occurred which include high blood potassium ; volume overload and uremia in acute condition while high blood pressure; anemia and heart disease in the chronic condition. There are several factors that may lead to the progress of acute renal failure conditions such as hypotension, a blockage of the urinary tract, hemolytic uremic syndrome and some medications.While diabetes ,hypertension, polycystic renal disease and nephrotic syndrome represent the major causes of chronic renal failure . Signs that help in identification of acute and chronic renal failure based on mishmash of several factors and help in distinguish between its types such as increasing of creatinine levels and decreasing of urine production are the signs of acute failure while decrease the rate of glomerular filtration to below of 15 or therapy with renal replacement are the signs of chronic renal failure. Acute failure can be treated depending on the main causes , on the other hand may use dialysis (hemodialysis or peritoneal dialysis) or kidney transplant in order treating chronic failure.

The WHO has revoked the COVID-19 pandemic status, but the disease remains a global health concern. One of the post-pandemic mitigation strategies is vaccination for children aged 6-11 years. Parents willingness to vaccinate children aged 6-11 years is important to prevent the recurrence of the COVID-19 pandemic or the like. The working area of the Mlandingan Health Center includes areas with low achievement of COVID-19 vaccination in children. This study aims to determine respondents willingness to vaccinate as a form of prevention against COVID-19 in children aged 6-11 years. This study used a cross sectional study approach. The results of the study were that there was an effect of the education level and ethnicity of the respondents on the willingness to vaccinate COVID-19 in children (p=0.001), while the generation group, gender, and marital status of the respondents had no effect (p>0.05) on the willingness to vaccinate COVID-19 in children aged 6-11 years. Perceived Susceptibility, Severity, Barrier, Benefits, Self-efficacy, and Cues to Action influence childrens willingness to vaccinate against COVID-19 with p-value = 0.001. From the results of this study, can be concluded that the parents willingness to COVID-19 vaccination in child aged 6-11 years, can be influenced by characteristic and perception of respondens.

Melasma, an acquired facial hyperpigmentation of a chronic nature, presents a clinical and dermatologic enigma of considerable relevance. This article focuses on a comprehensive review of the underlying pathogenesis of melasma from a molecular and clinical perspective, exploring its multifactorial etiology and the triggering elements that converge in the cascade of biochemical and cellular events that result in its distinctive clinical manifestation. Known risk factors such as excessive sun exposure, hormonal imbalances and genetic predisposition are thoroughly discussed, unraveling their relative contribution and complex interplay in the development of melasma. In addition, a critical analysis is made of current therapeutic strategies, ranging from conventional topical approaches to more advanced modalities such as laser therapy and technology-based treatments. The efficacy, safety and limitations of these modalities are examined, considering variations in patient response and the durability of the results obtained. Ultimately, this article seeks to provide a comprehensive synthesis of contemporary advances in the understanding and management of melasma, with the aspiration of guiding dermatologic health care professionals toward more accurate and individualized approaches in the diagnosis and treatment of this complex skin condition.

Background: Early in the COVID-19 outbreak, the government of Bangladesh instituted a transport lockdown and restricted peoples movement. The lack of proper transportation services, particularly for healthcare personnel and patients, is a major concern for Bangladesh during the COVID-19 pandemic. Methods: This cross-sectional study was conducted among 307 (101 patients and 206 nurses) transport service receivers including patient and health care workers (Nurses) at Khulna Medical College Hospital, Khulna. Data were collected through face-to-face interviews with the help of a semi-structured questionnaire to assess the state of the quality of transport services in tertiary public hospitals during the COVID-19 pandemic. Results: The result showed that, out of 307 respondents 206 (67.1%) were nurses, and the rest of them 101 (32.9%) were patients and their mean age was 35.07 ± 8.45 and 43.86 ± 14.00 respectively. Here, more than half of the nurses 114 (55.3%) stated that service quality was poor as well as 76 (36.9%) nurses stated that service quality was fair and the rest of the 6 (7.8%) nurses stated that service quality was good respectively. Vice versa more than half of the patients 53 (52.5%) stated that service quality was good as well as (22) 21.8% of patients stated that service quality was fair and the rest of them 26 (25.7%) patients stated that service quality was poor respectively. Conclusions: Hospital transport services play an important role in transporting infectious patients and healthcare workers during the lockdown and other times during the COVID-19 pandemic. Focusing on the safety and quantity of negative pressure transports, the existing experience of Bangladesh in the fight against the pandemic was more highly attacked than in other countries.

Introduction: Diabetes mellitus is a metabolic disease characterized by a defect in blood glucose regulation caused by alterations in pancreatic endocrine function, mainly due to a deficiency in the ß-cells of the pancreatic islets that are responsible for insulin secretion, or by loss of sensitivity to this hormone in the effector tissues. Obesity is defined according to the WHO as abnormal or excessive accumulation of fat that can be harmful to health and a body mass index (BMI) > 30 - 34.9 refers to grade I obesity, > 35 - 39.9 to grade II obesity and > 40 to grade III obesity. The main objective of this study is to know the prevalence among patients with a body mass index > 30 kg/m2 with poor glycemic control in type 2 diabetics. Material and methods: A retrospective observational study was carried out at the Clínica Hospital ISSSTE Irapuato, which lasted eleven months, and information was obtained from the database of the Integral Management of Diabetes by Stages (MIDE) program. The sample was taken from 86 patients, in a randomized manner. Results: 49.69% of the patients presented obesity, being the female sex and the age group > 60 years the most affected; the percentage of patients with obesity who presented glycemic dyscontrol was 45.71%, with the group > 60 years being the most prevalent. It was observed that patients who do not present obesity have a better glycemic control in 64.70% compared to those who are obese who obtained 54.28%. Discussion: The study sample was easily evaluated. The difficulties encountered were time and information collection, since several of the files were duplicated and the information had to be unified. Conclusion: We confirm the hypothesis that the higher the body mass index, the higher the glycemic dyscontrol, since patients with obesity show a glycemic dyscontrol up to 10.4 times more than those with a body mass index < 30 kg/m2 .

Background: drug shortage is a critical with severe negative impacts on patients outcome. It is a multifactorial problem in the world leading to increased cost of health, poor treatment outcomes and unnecessary patient referrals. Purpose: this study sought to examine the various causes of drug shortage in Aseer Hospital as a foundational investigation for improvement recommendations. To explore the factors affecting drug shortage and the magnitude of every factors influence in drug shortage. Material and methods: this study applied a cross sectional descriptive research design of the quantitative methodology. A questionnaire was electronically sent to the 177 sample for completion. The data was then analyzed using the descriptive statistics of Statistical Package for Social Services (SPSS), version 26. Results: a total of 177 questionnaires were completed. Out of the total sample, male gender dominated by 74.6% (n=132) while 25% were females. The dominant age group was (30-39) years old and most of the sampled pharmacists had bachelors in pharmacy 46.9% (n=83). In terms of experience at work, those who had worked for (5-10) years were the majority. Amongst the variables that contribute to drug shortage, this study found regulation and legislative processes (0.80=77.06%) as the major cause while imbalance between the supply and demand was the least cause (64.3%). There were other factors that contributed to drug shortage such as manufacturing problems (69.80%), drug distribution problems (69.0%) and human factor (65.57%). Conclusion: the study findings are in agreement with most of the previous scholarly findings that cited regulation and legislative process as one of the most causes of drug shortage.

Background: Gastric ulcer is a state that results from an imbalance between the erosive effect of acid and pepsin and the mucosal defense mechanism of the stomach; it is correlated with the lesions induced by ethanol. Methods: Forty-eight healthy albino rats weighing (150-200gm) were involved in the present study. The animals withholding food for 24hrs were allocated to six groups. Each group was given orally one of the following agents: distilled water for the control group, esomeprazole, aqueous extract of Ulmus rubra or Piper nigrum, or Brassica oleracea, then after one hour ethanol was given to all groups except group 1, which act as the control. Animals were sacrificed one hour later; the main parameters used in the present study were ulcer numbers and areas, preventive index, and changes in the trace elements (Zn and Cu) and serum electrolytes (Na+ and K+). Results: Ethanol was found to be highly ulcerogenic at high concentrations. The preventive index of these agents was 90%, 47.7%, and 91.8% for Ulmus rubra, Piper nigrum, and Brassica oleracea, respectively, in comparison with esomeprazole 94.7%. These agents also produced significant changes in trace elements levels of Zn and Cu but with no significant changes in electrolytes Na+ and K+. Conclusion: Both Ulmus rubra and Brassica oleracea extracts proved to have a potent gastroprotective effect against the ethanol-induced model of gastric ulcer and the possibility to be used in the management of peptic ulcer after assessment by clinical trials.

We present the case of a 51-year-old woman with a history of atrial fibrillation and rheumatic heart disease who underwent a prosthetic mitral valve replacement two years ago. Despite receiving anticoagulant therapy, this patient experienced embolisms, including embolic strokes and a coronary embolus, over a month. Following a cardiology evaluation, it was determined that mechanical valve thrombosis was the primary source of embolism, and embolisms ceased following a replacement. This case report illustrates the difficulty in diagnosing prosthetic valve thrombosis as a source of multiple emboli in patients receiving adequate anticoagulant therapy, a rare but potentially fatal complication of mechanical valve replacement.

Introduction: Effective communication is one of the most essential aspects of nursing care in the emergency room. In Saudi Arabia, the emergency department must exert considerable effort to surmount communication barriers. Due to the fact that the majority of emergency department personnel in different regions of the United Kingdom are immigrants from other countries who speak other languages, there is a communication barrier that must be surmounted in order to overcome the communication risks in ER. Aims: To determine the perceived communication barrier in Saudi emergency departments. Methods: Samples were extracted from each individuals inter-emergency department for a descriptive community-based survey. Between August and November of 2022, 1507 samples were collected from participants over the age of 18 for the study. The data was collected using a standard, closed-ended questionnaire. Results: According to emergency nurses, environmental factors are the primary barrier to effective nurse-patient communication. The following were elements related to knowledge and psychology. As with younger nurses versus elder nurses, male nurses viewed knowledge-related variables as a greater communication barrier. The influence of languages and educational attainment on environmental factors was also substantial. Conclusion: Language, culture, and educational differences between Saudi patients and foreign nurses have created communication barriers between them. We recommend that nurses participate in ongoing training to enhance their communication abilities.

Preventing Covid-19 by wearing a face mask is a mandatory policy. The implementation of this policy is now reaping very complex problems. Where the waste generation of face masks is very large, reaching 1,662.75 tons in September 2020. Disposable face mask waste with polypropylene as the main ingredient encourages the formation of microplastics in the environment. The community managing face masks often have technical problems where, where, and when this face mask waste can be managed properly so that it does not pollute the environment. The purpose of the study was to determine the determinants of facial mask waste management as a health behavior to protect the environment. The research method is quantitative research through a descriptive online survey approach. The population in this study were all parents of Public Health Study Program students. A total research sample of 88 respondents filled out a questionnaire via Google form. Univariate data were analyzed by percentage distribution. Based on the results of the research that has been done, it is found that most parents are the general public, meaning that they are not community leaders / religious leaders, have a higher education, are female, are not health workers, have jobs that are not government employees, earn below the Regional Minimum Wage (UMR), have sufficient knowledge, have a supportive attitude, but do not have access to the unit Waste Bank and special face mask bins in the neighborhood, do not have experience in participating in face mask waste management counseling activities, have never played a role in face mask waste management counseling, and do not carry out face mask waste management.

A clinical case is presented at the Hospital Centenario Miguel Hidalgo with a diagnosis of pulmonary thromboembolism with a thrombus in transit and dysfunction of the right cavities, secondary to immobilization due to a history of previous spinal surgery as an ankylosing spondylitis treatment. He was admitted to the emergency room with typical symptoms of the entity, evidenced by angiotomography, later a transthoracic echocardiogram was performed, presenting the characteristic echocardiographic signs of right ventricular dysfunction and evidence of mobile thrombus in the right cavities, for which reason fibrinolytic therapy was decided with success, evidenced in transthoracic echocardiography with improvement of ventricular systolic function and strain.

Constrictive pericarditis secondary to radiation is a rare complication, due to its pathogenesis, the patient may present asymptomatic for a long period of time with a slight decrease in functional class that may go unnoticed, however, once constrictive physiology is established, presents greater functional deterioration, and favors the development of predominant arrhythmias, atrial fibrillation and preserved LVEF heart failure, the clinical course of the disease is progressive with high morbidity and mortality. The patient presented in the case report refers to the timely diagnosis through the different methods explained that leads to a favorable outcome.

Dermatitis herpetiformis (DH) emerges as a chronic, immune-mediated, systemic skin pathology closely linked to celiac disease (CD). Characterized by polymorphous and pruritic cutaneous manifestations, DH presents a unique clinical and diagnostic challenge. In this article, we seek to comprehensively delineate the clinical, histologic, and immunologic dimensions of DH, with particular emphasis on its etiopathogenic association with CD. The underlying autoimmune cascade involving the interaction between immunoglobulin A (IgA) and tissue transglutaminase is examined, with crucial implications in the pathogenesis of DH. As understanding of immunologic mechanisms expands, the diverse spectrum of clinical presentations of DH is explored, highlighting the variability in skin lesion morphology and its correlation with histologic findings. In the therapeutic arena, conventional and emerging approaches are reviewed, ranging from dapsone-based drug therapy to nutritional and pharmacologic interventions aimed at suppressing the abnormal immune response. As research advances, it is essential to further the early diagnosis and integrated management of DH, addressing both cutaneous symptoms and systemic implications, to improve patients quality of life and provide comprehensive and insightful clinical care.

Medical applications for nanotechnology are the most important applications of this modern technology among all applications because of its direct link to human life and health. Nanotechnology promising to innovate a lot of medical applications related to accurate diagnosis and treatment of high efficiency as well as many applications in the field of health care, facing the most deadly diseases in humans such as cancer. Nanomedicine is the application of medical nanotechnology that will lead to the development of research methods, advanced drug delivery systems, new ways to treat disease or repair damaged tissues and cells. Delivering drug in this era is the most advanced application of nanotechnology in the field of medicine. Nanoparticles are being developed to improve the biological availability of conduction, and a major constraint in the design of new lipid-based or polymer-based polymer molecules is due to their small size, rather than being discharged from the body. These nanoparticles can be used on shuttle drugs in cells that may not be drug-free on their own. Nanoparticles may be specifically capable of targeting certain cell types, reducing toxicity and improving efficacy. The aim of this descriptive minireview, generally, is to shed light on the main Applications of Nanoparticles in Medicine.

In Mexico, dog bite injuries have an incidence of 110.44 per 100,000 inhabitants. In more than half of the cases the attack was by family or neighbor dogs; an important factor in determining the severity of the injuries is the breed of the dogs. Of the bites on the face, the nose and lips are the most affected sites. Bites in this area should be sutured soon because of the infrequent infectious complications. A clinical case is presented of a 62-year-old female patient who was bitten on the nose and lip by her Rottweiler breed dog while being fed.

Aim: The aim and objective of the study is to evaluate the prescription pattern of anti-plateletic agents used in the treatment of stroke and clinical symptoms and risk factors, among hospitalized stroke patients. Materials and Method: A six-month prospective observational study that was carried out in the neurology department. A standard procedure was followed for the documentation and analysis of all the data. A total of 120 patients selected for the study who satisfying the inclusion and exclusion criteria. Results: Out of total 120 patients, the most prevalent type of stroke was found to be ischemic stroke of 92%. Females were found mostly to be diagnosed by stroke. Aspirin (65%) was found to be the most common anti-plateletic agent used in the treatment of stroke followed by clopidogrel and its combination. Majority of patients experienced slurred speech (37.5%), followed by weakness as the clinical presentation of stroke. Hypertension (49.1%) was found to be the most prevalent risk factor of stroke followed by diabetes mellitus. Conclusion: The study provides a concise summary of the clinical symptoms, risk factors, and prescription pattern of anti-platelet therapy in stroke patients. By proper identification and rectification of the strong contributable risk factor for stroke may lead to a good prognosis of treatment of stroke. Article Details

Definition: Inguinal hernias are characterized by the protrusion of tissues through a weakness in the abdominal wall in the inguinal region. They are divided into direct and indirect hernias, with anatomical differences influencing the choice of surgical technique. Types of Hernias and Surgical Management: The surgical approach is based on individual and symptomatic considerations. Asymptomatic hernias may be observed, while symptomatic ones usually require intervention. Mesh repair is a common technique, with both open and laparoscopic repair options. The choice is based on the patients anatomy and the surgeos experience. Complications: Despite progress, recurrences remain a concern. Careful selection of technique and attention to mesh placement can reduce this rate. Postoperative complications, such as infections and chronic pain, are also concerns to consider. Discussion: The discussion focuses on the choice between open and laparoscopic repair techniques. Adaptation to the patients individual conditions, such as age and comorbidities, is essential. Research and innovation continue to play a crucial role in improving outcomes and preventing complications. Conclusions: The surgical management of inguinal hernias is a balance between tradition and innovation. Collaboration between surgeons and constant research are critical to advancing the field. The individualized approach and continuous improvement of techniques and materials will continue to provide patients with a better quality of life and more positive outcomes in the future.

This was a cross-sectional type of descriptive study that was carried out with a view to assessing knowledge and practice regarding self-medication of analgesic drugs of the students of the Nursing Institute, Naogaon. The sample size was 175 which were selected purposively. The mean age was 19.34±0.95 years. Here, 56.0% knew self-medication practice is a bad habit for a nursing student, 92.0% of respondents said that pain-relieving drugs are dangerous without anti-acid drugs, 60.0% told that self-medication practice is completely unethical, most 85.7% told that purchase of medicine needs a prescription, 67.43% respondents took medicine without doctor`s advice. This study provides some important information which might help the concerned people to take appropriate measures and might be the basis for further in-depth study on this issue.

This literature review article comprehensivelya addresses the risk factors that contribute to stomatal complications, a major concern in current medical practice. The creation of stomata, surgical interventions to bypass intestinal or urinary contents, is valuable but can be accompanied by problems that affect the quality of life of patients. Definition and Types of Complications: Complications in stomata range from necrosis of stomal tissue to prolapse and irritation of the surrounding skin. These complications can affect both stoma function and skin integrity, and understanding them is essential for informed clinical practice. Risk Factors for Complications: The discussion focuses on risk factors that predispose to stomatal complications. Older age, obesity, and medical comorbidities, such as diabetes and cardiovascular disease, increase the likelihood of complications. The choice of surgical technique and the site of creation of the stoma also influence the occurrence of problems. Preoperative Education and Preparation: Patient education and preoperative preparation are crucial elements in preventing complications. Patients should receive detailed information about stoma self-care and possible signs of complications. Proper preoperative preparation, which addresses pre-existing medical conditions, can mitigate risk factors. Discussion: The discussion highlights the importance of a comprehensive evaluation and adaptation of surgical and postoperative planning according to individual risk factors. Emphasis is placed on the need for proper surgical technique and on the experience of the surgeon in creating stomata. Conclusion: In conclusion, the creation of stomata is a valuable technique but not without challenges. Early identification and management of risk factors are critical to reducing the incidence and severity of complications. Patient education, careful planning, and preoperative preparation are essential to achieving optimal long-term results in stomatal management.

Objective: We aimed to investigate treatment outcomes, treatment failure rates, factors causing failure, and complications of treatment in patients followed up with ectopic pregnancy and receiving methotrexate (MTX) treatment. Materials and methods: All ectopic pregnancies in a tertiary perinatology center who had single dose MTX between January 2015 and January 2021 were retrospectively included in this study. The demographic data of the women (age, gravida, parity, abortus numbers) and delivery [normal and cesarean sectio (C/S)] types were analyzed. The size of the mass, ß-hCG level, presence of intra-abdominal free fluid and USG findings were recorded. The effectiveness of the treatment and the need for surgical treatment after MTX treatment were also investigated. Results: Overall, 93 ectopic pregnancies who had single dose MTX treatment were included in this study. The mean age was 30.4 years (SD ± 5.2). Previous ectopic pregnancy rate was 9.9% and 13.6% had free fluid in the abdomen. More than one third (35.8%) had undergone previous surgery and 8.6% had chronic disease. The median ß-hCG level was 1763 mIU/ml (minimum 129 – maximum 67854, IQR 1010 - 2723 mIU/ml). The mean size of the mass was 9.3 mm (SD±6.1). A single dose of MTX treatment was found to be effective in 51.9%. ß-hCG levels at the time of admission, mass size, patients age and pregnancy week were not effective on the success of single-dose MTX treatment. Conclusion: Single dose MTX therapy is used effectively and safely in the first treatment of ectopic pregnancy.

Definition: Lupus nephritis involves chronic inflammation of kidney tissue in patients with SLE, which can lead to structural and functional damage. Clinical Manifestations: Its symptoms range from mild, such as proteinuria and hematuria, to severe, including kidney failure. Patients may experience fatigue, swelling, and changes in urination. Diagnosis: Based on clinical findings, urinalysis, serological tests, and renal biopsies to assess severity and guide treatment. Treatment: Includes corticosteroids and other immunosuppressants. The therapy is personalized and closely supervised by a multidisciplinary team. Complications: Chronic kidney failure, cardiovascular disease, and infections are major concerns. Patient education and comprehensive care are crucial.

Facial fistulas represent a complex and challenging complication in the field of reconstructive plastic surgery. This study aims to perform an exhaustive clinical characterization of facial fistulas, considering their diverse etiologies, clinical presentations and associated risk factors. In addition, diagnostic evaluation is addressed in detail, including advanced imaging techniques and functional tests, with the aim of achieving optimal diagnostic accuracy. In this context, the present article seeks to shed light on contemporary surgical strategies for the management of facial fistulas, emphasizing reconstructive and reparative options that allow comprehensive restoration of facial anatomy and function. The application of customized therapeutic approaches is critically examined, considering the extent and location of the fistula, as well as the patients underlying clinical conditions. The review also considers the technological advances and innovative techniques that have revolutionized the approach to facial fistulas in modern plastic surgery. The benefits and limitations of minimally invasive approaches, biomaterial agent therapies, and precision instrumentation-assisted primary closure methods are discussed in detail. In summary, this article provides a comprehensive and up-to-date overview of facial fistulas in the context of reconstructive plastic surgery, integrating clinical, diagnostic, and therapeutic knowledge. A detailed understanding of this complication and the informed application of advanced therapeutic approaches are crucial to optimize clinical outcomes and improve the quality of life of patients undergoing facial reconstructive procedures.

Background: Several medications such as dexmedetomidine can be used as adjuvants with anesthesia to reduce the stress response during surgery resulting in good post-operative outcomes and safe recovery times. Aims: To compare the peri-operative outcomes of subtenon block with or without dexmedetomidine versus dexmedetomidine infusion as adjuvants to general anesthesia in subjects undertaking retinal operations. Design: A prospective randomized double-blind controlled clinical trial Patients and methods: Through the use of sealed opaque envelopes, 120 participants were randomly divided into three groups. Group SB received subtenon bupivacaine and lidocaine and IV infusion of normal saline. Group SD received subtenon bupivacaine, lidocaine, and dexmedetomidine and IV infusion of normal saline, whereas Group DI received subtenon saline and IV infusion of dexmedetomidine. Peri-operative hemodynamics and intra-ocular pressure were measured and recorded. Intra-operative bleeding, recovery times, post-operative sedation and pain scores, first analgesic times, total analgesic requirements, and the incidence of PONV and OCR were also assessed and documented. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The results showed that IV dexmedetomidine has decreased cardiovascular responses to surgery as signified by decreased HR and MAP with a significant drop in IOP measurements before induction and after intubation, in comparison to other groups. Administering dexmedetomidine either or IV in the subtenon block led to a significant reduction in pain scores of the first post-operative six hours, the total pethidine consumption, and the surgical bleeding. Conclusion: When used as a supplement to general anesthesia during retinal surgery, dexmedetomidine is effective at reducing the airway response to tracheal intubation and extubation and maintaining peri-operative hemodynamic stability. Dexmedetomidine is also an efficient method for lowering intraocular pressure, surgical bleeding, and postoperative analgesic consumption with a better recovery profile. It can be administered either through IV infusion or combined with local anesthetics in subtenon block.

Pediatric surgical wound care is a critical aspect of medical practice, necessitating innovative approaches to optimize healing and minimize complications. Platelet-rich plasma (PRP) therapy has emerged as a promising intervention for enhancing wound healing in pediatric patients. This review comprehensively evaluates the efficacy, underlying mechanisms, and challenges associated with platelet-rich plasma (PRP) therapy in the context of pediatric surgical wounds. Platelet-rich plasma (PRP), a biologic concentrate enriched with growth factors and cytokines, plays a pivotal role in wound healing by promoting cell proliferation, differentiation, and tissue regeneration. This article explores the mechanisms of action of this therapy in detail, focusing on its immunomodulatory effects and interaction with growth factors, and highlighting the significance of factors influencing platelet-rich plasma (PRP) efficacy, This article also gives examples of platelet-rich plasma (PRP) therapy in various pediatric surgical procedures, summarizes outcomes from clinical studies and trials, and addresses safety concerns and potential adverse effects associated with platelet-rich plasma (PRP) therapy in pediatric surgical wound management. In conclusion, this review underscores the potential of platelet-rich plasma (PRP) therapy as an adjunctive treatment in pediatric surgical wound care. By elucidating its mechanisms, clinical efficacy, and challenges, the review provides insights for clinicians and researchers to guide evidence-based practice. Recommendations for future research and the integration of platelet-rich plasma (PRP) therapy into clinical guidelines emphasize the importance of refining protocols, ensuring cost-effectiveness, and adhering to ethical standards in pediatric surgical wound care.

The present article stands as a thorough and holistic exploration of Alport syndrome, a uniquely complex inherited nephropathological entity involving a myriad of etiological, clinical and therapeutic aspects. Through a meticulous synthesis of the current scientific literature, this review encompasses a comprehensive appreciation of the underlying genetic basis of the disease, characterized by an aberrant expression of type IV collagen proteins in the glomerular basement membrane, which precipitates a cascade of pathophysiological events with multisystemic implications. The clinical manifestations of Alport syndrome, although classically centered on progressive nephropathy with hematuria and proteinuria, have evolved to include a plethora of variant phenotypes affecting not only the renal, but also the auditory and ocular systems. This phenotypic expansion demands a meticulous differential diagnostic approach, supported by advanced imaging techniques, auditory function studies, and precise genetic analysis, for the sake of early and accurate identification of the condition. Early and accurate diagnosis of Alport syndrome is an essential pillar for effective clinical management and the application of appropriate therapeutic strategies. In this context, the available therapeutic approaches are reviewed in detail, ranging from conservative renal disease therapy to innovative pharmacological interventions and, in some cases, renal transplantation. The importance of multidisciplinary care and genetic counseling for affected families is also discussed, in line with the comprehensive approach to this multisystemic and hereditary condition. In summary, this comprehensive review of Alport syndrome amalgamates a deep appreciation of its genetic, pathophysiological and clinical aspects, while promoting the imperative need for a collaborative, multidisciplinary approach to its proper management. Through the integration of advanced medical research and clinical experience, we aspire not only to a more acute understanding of this entity, but also to a substantial improvement in the quality of life of the patients who suffer from it.

SARS-CoV-2 is a type of corona virus that infects humans with pneumonia, and it began spreading in Wuhan, China, in late December of last year. So far, there is no cure for the emerging corona virus, and it is spreading rapidly, recording more than 200 million infections and deaths in large numbers. It is possible that infection with the emerging corona virus may be accompanied by some different symptoms, which are: cough, high temperature and shortness of breath. The Corona virus (SARS-CoV-2) has occupied a special importance since it invaded the world in 2020, and perhaps we do not exaggerate if we say that this unprecedented pandemic of the twenty-first century has changed many features of people s lives in it, and this virus has appeared in several different mutations, as The severity of the virus increased and became more resistant to the vaccine. The aim of this descriptive minireview, generally, is to shed light on the mergence of different mutations in SARS-CoV-2 and the long term of Covid-19 impact.

Chemotherapy refers to the role of drugs in trying to destroy or stop the development and spread of cancer cells in the body. Although it is one of the common types of treatment for cancer patients, not all patients need chemotherapy as part of their treatment, as it depends on their specific diagnosis, and sometimes chemotherapy is given only to reduce the size of cancer cells before surgery. Chemotherapy at the Specialized Hospital aims to: Treat cancer diseases and prevent their recurrence. Controlling cancerous disease by reducing the size of tumors or preventing them from growing and spreading to other parts of the body and relieving symptoms in patients who have cancer spread in their bodies to improve their quality of life and their treatment of cancer